欧普乐喉罩在侧卧位腹腔镜肾切除术中的临床应用

THE CLINICAL APPLICATION OF OPLAC IN LATERAL POSITIONED LAPASCOPIC NEPHRECTOMY SURGERY

目的研究欧普乐喉罩在全身麻醉侧卧位后腹腔镜肾切除术中的应用。方法选取ASA分级Ⅰ～Ⅱ级择期行侧卧位腹腔镜肾切除术患者60例,随机分为欧普乐喉罩组(O组)和气管内插管组(T组),每组30例。静脉快速诱导后分别置入欧普乐喉罩和气管内插管。观察插管时间、一次插管成功率、心率、血压、密封压、气道压力的变化及不良反应。结果 O组置管时间(12.1±3.0)s,显著短于T组(31.8±5.8)s(P<0.05)。T组置管后收缩压显著高于置管前(P<0.05)。O组侧卧位气道密封压显著低于平卧位(P<0.05);T组侧卧位气道峰压和平均气道压显著高于平卧位(P<0.05);O组气腹后气道峰压和平均气道压显著高于侧卧位(P<0.05);T组气腹后气道峰压和平均气道压显著高于侧卧位(P<0.05);T组侧卧位和气腹后平均气道压显著高于O组(P<0.05)。2组的染血发生率和咽痛发生率差异无统计学意义(P>0.05)。结论欧普乐喉罩具有操作简便快速,通气功能良好,患者耐受性好,术后并发症少的特点,可用于侧卧位腹腔镜肾切除手术。

Objective To evaluate the effect of oro -pharyngo- laryngeal airway cap （Oplac） in airway management of lateral positioned lapascopic nephrectomy surgery. Methods Sixty patients between ASA Ⅰ - Ⅱ receiving laparoscopic nephrectomy was selected, and randomly divided into group Oplac（ group O）,30 eases, and group endotracheal intubation group （group T）, 30 cases, using Oplac and endotracheal intubation tube, performing volume controlled mechanical ventilation after rapid induction. Intubating time, the difficulty level of insertion, influence on hemodynamic, maximum sealing pressure, respritory parameters and postoperative adverse reaction were recorded and analyzed. Results The intubating time of group O（ 12.1 ±3.0）s was significantly shorter than that of group T （31.8 ± 5.8 ）s （ P 〈 0.05 ）. Both groups＇ airway pressure had marked difference between horizontal and lateral position （P 〈 0.05 ） , and also differed between lateral position and after pneumoperitoneum （ P 〈 0.05 ）. The average airway pressure of group T was higher than group O （ P 〈 0.05 ）. The incidence of postoperative throat complications in 24 hours had no significant difference （P 〉 0.05）. Conclusion Oplac could be safely used in airway management of lateral positioned lapascopic surgery. It could be intubated easily and rapidly,it＇s tolerable ,and has low risks of severe postoperative complications.