一次性双管喉罩行正压通气用于腹腔镜胆囊切除术疗效观察

Effective observation on disposable double-pipe laryngeal mask for positive pressure ventilation during laparoscopic cholecystectomy

目的评价一次性双管喉罩（supreme laryngeal mask airway,SLMA）行正压通气用于腹腔镜胆囊切除术的疗效。方法对100例ASA分级Ⅰ、Ⅱ、Ⅲ级全麻下腹腔镜胆囊切除术患者行观察研究。所有患者置入SLMA,记录口咽部漏气压、术后咽喉痛及其他并发症。外科医生在插入腹腔镜和气腹减压前记录胃尺寸。结果所有患者插入SLMA成功（90例1次成功,10例2次成功）。所有患者均成功插入胃管（98例插入容易,2例插入困难）。平均口咽部漏气压为60cm H2O,套囊压力水平为（28.8±5.2）（18~40）cm H2O。气腹前平均气道压为（17.3±3.5）（11~26）cm H2O,气腹后为（22.9±4）（16~32）cm H2O。手术中胃尺寸的变化并不干扰操作。12例患者（12%）术后有轻微的咽喉痛。结论 SLMA不仅易于置入,而且是行腹腔镜胆囊切除术的一种有效通气装置。

Objective To evaluate the effects of disposable double-pipe supreme laryngeal mask airway（SLMA） in the patients undergoing laparoscopic cholecystectomy.Methods 100 adult patients,ASA physical status 1,2,and 3,undergoing laparoscopic cholecystectomy under general anesthesia were enrolled in this observation study.SLMA was inserted in all study patients.The oropharyngeal leak pressure,postoperative sore throat and other complications were recorded.The surgeon recorded stomach size at insertion of laparoscope and before decompression of pneumoperitoneum.Results Insertion of SLMA was successful in all patients（90 cases on the first attempt,10 cases on the second attempt）.Gastric tube insertion was successful in all patients（easy in 98 cases,difficult in 2 cases）.Mean oropharyngeal leak pressure at 60 cm H2O,cuff pressure level was（28.8±5.2（18-40）cm H2O.Mean airway pressure before pneumoperitoneum was（17.3±3.5）（11-26）cm H2O and（22.9±4）（16-32）cm H2O after pneumoperitoneum.Change in stomach size during surgery did not interfere with the procedure in any patient.12 cases（12%） complained of a mild sore throat postoperatively.Conclusion SLMA is easy to insert and is an effective ventilatory device for laparoscopic cholecystectomy.