喉罩在直视下微创胆囊切除术中的应用研究

The Research of the Application of Laryngeal Mask Airway under Direct Vision in Minimally Invasive Cholecystectomy

目的观察喉罩和气管插管在直视下微创胆囊切除手术中对平均动脉压(MAP)和心率(HR)的影响。方法 40例直视下微创胆囊切除手术患者随机分成喉罩组和插管组,每组20例。用咪哒唑仑0.03 mg/kg、芬太尼3～4 g/kg、丙泊酚2～2.5 mg/kg、维库溴铵0.1 mg/kg麻醉诱导后置入喉罩或气管插管。观察两组患者置入喉罩或气管插管前后、术中、拔除喉罩或气管导管前后各时点MAP及HR的变化,观察患者术中用药情况、苏醒时间、术后随访患者咽喉部并发症的发生情况。结果与进入手术室(T0)相比,两组患者在置入喉罩后和气管插管后不同时间点MAP、HR均明显降低,两组比较差异有统计学意义(P<0.05),喉罩组与气管组组间比较差异有统计学差异(P<0.05);两组不同时间点插管组MAP及HR波动较喉罩组明显,差异有统计学意义(P<0.05)。结论在直视微创胆囊手术中,采用喉罩进行全麻通气,MAP及HR平稳,苏醒时间缩短,值得临床推广。

Objective To observe the influence of laryngeal mask and tracheal intubation on mean arterial pressure（MAP） and heart rate（HR）under direct vision in minimally invasive gallbladder removal surgery.Methods The patients were randomly divided into two groups：laryngeal mask and intubation group,20 cases each.For the induction of anesthesia,midazolam 0.03 mg/kg,fentanyl 3-4 μg/kg,propofol 2-2.5 mg/kg,and vecuronium 0.1 mg/kg were administered.After administration into the laryngeal mask or endotracheal tube,patients′ MAP and HR changes were observed before and after laryngeal mask or endotracheal tubeat different time points.Medication during the surgery,consciousness regaining time,throat complications after the surgery discovered during the follow-up were observed.Results Compared with entering the operating room（T0）,after induction MAP and HR were obviously lower（P〈0.05）at different time points in both groups with statistically significant differenceDifference between the laryngeal mask group and intubation group was statistically significant（P〈0.05）.At two different time points intubation group MAP and HR fluctuations were obviously higher than the laryngeal mask group（P〈0.05）.Conclusion In minimally invasive direct vision gallbladder surgery,the use of laryngeal mask airway anesthesia is featured with shorter recovery timeand stable MAP and HR,which is worthy to be popularized.