食管引流型喉罩在全麻腹腔镜胆囊切除手术中的临床应用研究

Clinical study on application of ProSeal laryngeal mask during general anesthesia laparoscopic cholecystectomy

目的探讨食管引流型喉罩在全身麻醉腹腔镜手术中的应用。方法择期手术病人80例,ASA Ⅰ或Ⅱ级,随机分为两组,全麻诱导后分别插入喉罩(Ⅰ组)和气管插管(Ⅱ组),分别记录麻醉诱导前(T_0,基础值)、插管(罩)即刻(T_1)、插管后1 min(T_2)、插管后5 min(T_3)、气腹后5 min(T_4)、气腹后10 min(T_5)、放气腹后1 min(T_6)、拔管(罩)后(T_7)的血压、心率、相关呼吸参数[呼吸末二氧化碳(P_(ET)CO_2)、吸入和呼出潮气量(Vti和Vte)、吸入和呼出分钟通气量(MVi和MVe)、气道峰压(Ppeak)和平台压(Pplat)、肺顺应性(CL)及气道阻力(Raw)]及观察不良反应发生情况。结果 T_0时两组平均动脉压(MAP)和心率(HR)差异无统计学意义(P>0.05);麻醉后Ⅱ组较Ⅰ组HR增快、MAP升高(P<0.05);气腹后较气腹前P_(ET)CO_2明显升高(P<0.05);Ⅰ组与Ⅱ组比较,术后咽部不适、术后咽痛差异有统计学意义(P<0.05)。结论食管引流性喉罩可以安全有效地用于腹腔镜胆囊切除术。

Objective To investigate the effect of application of the ProSeal laryngeal mask during general anesthesia laparoscopic surgery. Methods Eighty ASA Ⅰ or Ⅱ patients undergoing elective surgery were randomly divided into two groups group received tracheal intubation. After induction of general anesthesia, laryngeal mask group received PmSeal laryngeal mask （ Ⅰ group）, and tracheal intubation group received tracheal intubation （ Ⅱ group）. Before induction （T0, baseline）, immediately before intubation （mask） （T1 ）, at 1 min after intubation （T2 ）, at 5 min after intubation （T3 ）, at 5 min after pneumoperitoneum （ T4 ）, at 10 min after pneumoperitoneum （T5 ）, at 1 min after pneumoperitoneum release （T6）, after extubation （mask） （T7） blood pressure, heart rate; related respiratory parameters： Inhaled and exhaled tidal volume （Vti and Vte）, inhalation and exhalation of minute ventilation （MVi and MVe）, peak airway pressure （Ppeak） and plateau pressure （Pplat）, lung compliance （CL） and airway resistance （Raw）were recorded ;The side effects were observed. Results The difference in To MAP and HR between the two groups was not significant （P 〉 0. 05） ; Compared with Ⅰ group, HR was faster and MBP was ligher in Ⅱ group after anesthesia （P 〈 0.05） ; compared with PETCO2 before pneumoperitoneum, PETCO2 after pneumoperitoneum incrensed significantly. There was significant difference in post operative throat discomfort and sore between two groups （P 〈 0. 05）. Conclusion The ProSeal laryngeal mask is safe and effective for laparoscopic cholecystectomy.