腹腔镜手术患者i-gel喉罩气道管理的效果

Effect of laryngeal mask i-gel on airway of patients undergoing laparoscopic surgery

目的评价i-gel喉罩应用于腹腔镜手术患者气道管理的效果。方法择期妇科腹腔镜手术及腹腔镜胆囊切除手术50例,男女不限,20-60岁,体质量50-80kg,BMI<30kg/m2,ASAⅠ-Ⅱ级,无喉罩使用禁忌证,随机分为i-gel喉罩组(I组)和supreme喉罩组(S组)(n=25)。患者入室常规监测,麻醉诱导后按分组分别置入4号i-gel及supreme喉罩,记录喉罩置入时间,一次喉罩置入成功率,并测定最高气道密闭压。调整VT为8ml/kg,RR为10次/min,术中依据PetCO2调整RR,记录气腹前后气道压及平均气道压。术后随访喉罩相关并发症。结果两组喉罩均100%置入成功,第一次置入成功率均为92%(P>0.05)。两组患者机械通气时气道峰压在气腹后明显高于气腹前,但均低于气道密闭压(P<0.05)。两组患者气腹前后通气效果良好,无低血氧症等不良事件发生。S组有2例患者在拔去喉罩时带有血丝,两组患者术后各有1例发生咽痛。结论与supreme喉罩相似,i-gel喉罩置入成功率高,气道密闭性可靠,术后不良反应少,可安全有效应用于腹腔镜短小手术。

Objective To assess the effect of laryngeal mask i-gel（LMA i-gel） used on airway of patients undergoing laparoscopic surgery.Methods Fifty ASAⅠorⅡpatients who aged 20-60 years and weighted 50-80kg,undergoing selective laparoscopic surgery,with no contraindications for laryngeal mask on airway and with their BMI30kg/m2,were divided into i-gel group（group I） and laryngeal mask supreme group（group S）,25 in each group.After the LMA supreme and i-gel（size 4 each） were inserted into the patients of group S and group I after anesthesia.The duration of inserting LMA and the success rate of first try of insertion were recorded.The peak airway pressure was measured.Then,the VT and RR were adjusted to 8ml/kg and 10bpm,respectively.The RR was adjusted during operation according to the PetCO2.Max and mean airway pressure were recorded before and after pneumoperitoneum.The patients were followed up for LMA i-gel-related complications after operation.Results A 100% success rate for LMA insertion was achieved in the two groups and both the first insertion success rate for LMA was 92%（P0.05）.The peak airway pressure was significantly higher after pneumoperitoneum than before pneumoperitoneum during mechanical ventilation（P0.05）.However,it was lower than the airway sealing pressure in the two groups（P0.05）.The ventilation effect was good in the two groups after pneumoperitoneum with no adverse reactions occurred such as hypoxemia.The blood stain was observed on the LMA removed from 2 patients of group S and 1 patient of each group had sore throat.Conclusion The success insertion rate of LMA i-gel is as high as that of LMA supreme,with a reliable airway sealing pressure and few postoperative complications,and can thus be used in small laparoscopic operation.