欧普乐喉罩在腹腔镜手术中的通气效果观察

Observation of ventilation effect of OPLAC-LMA in laparoscopic operation

目的比较传统气管插管和欧普乐喉罩在腹腔镜手术中的通气效果。方法拟行腹腔镜手术患者100例,ASAⅠ或Ⅱ级,体重指数<30kg/m2,随机分为两组,气管插管组(A组,n=50)和欧普乐喉罩组(B组,n=50)。两组均靶控输注异丙酚(血浆靶浓度3～5μg/mL)和瑞芬太尼(血浆靶浓度4～6ng/mL),静脉注射维库溴铵0.12mg/kg,待BIS40～60时插入适宜型号的气管导管或置入欧普乐喉罩,置入成功后,记录气管导管插入时间和喉罩置入时间、一次置入成功率和气道密封压、拔出时呛咳、呕吐、屏气和喉痉挛发生情况,术后24h咽痛及肺部感染发生率。术中持续监测BP、HR、ECG、SpO2、PETCO2、PpeaK、PCO2。记录手术时间、气腹时间、清醒时间、拔出时间。结果两组置入时间,一次置入成功率、气道密封压、苏醒时间,拔出时呛咳、呕吐、屏气和喉痉挛发生情况、术后24h咽疼及肺部感染发生率比较,差异均无统计学意义(P>0.05)。两组患者术中血流动力学平稳,SpO2、PpeaK、PETCO2、PCO2均在正常范围,且差异无统计学意义(P>0.05)。结论欧普乐喉罩可有效的用于上腹部腹腔镜类手术,安全性良好,其通气效果与传统气管插管无差异。目前某些国家和地区在全麻中使用的比例已经大于传统气管插管。随着喉罩的不断改进,几乎可以替代气管插管。

Objective To compare the ventilation effect between conventional endotracheal intubation and OPLAC-LMA in laparoscopic operation. Methods One hundred cases of patients with ASA I - II grade, BMI〈30 kg/m2 underwent laparo- scopic operation were randomly divided into endotracheal intubation group （group A, n = 50） and OPLAC-LMA group （group B, n = 50）. Two groups were all treatment with target controlled infusion of Propofol （target concentrations of plasma was 3-5 μg/mL） and Remifentanil （target concentrations of plasma was 4-6 ng/mL）, intravenous injection of Vecuronium 0.12 mg/kg, then the appropriate type of tracheal catheter or OPLAC-LMA was inserted or placed when the BIS was 40- 60. After successful placement, the tracheal catheter inserted time, LMA placement time, the success rate of one-time placement, airway sealing pressure, occurrence of cough, vomiting, breath-holding and laryngeal spasm when extubation, incidence of pharyngeal pain and pulmonary infection after 24 h of operation were recorded. Intraoperative BP, HR, ECG, SpO2, PETCO2, PpeaK, PCO2 were continuous monitored, and the operation time, time, pneumoperitoneum time, awake time, extubation time were record. Results The differences in placement time, success rate of one-time placement, airway sealing pressure, awake time, occurrence of cough, vomiting, breath-holding and laryngeal spasm when extubation, inci- dence of pharyngeal pain and pulmonary infection after 24 h of operation of two groups were not significant （P 〉 0.05）. In- traoperative hemodynamics was smooth of patients in two groups, the SpO2, PETCO2, PpeaK, PCO2 were all in the normal range, and the differences of two groups were not significant （P 〉 0.05）. Conclusion OPLAC-LMA can be used in upper abdominal laparoscopic operation effectively, which has good safety. Compared with traditional tracheal intubation, the ven- tilation effect of OPLAC-LMA has no significant difference, and at present the use ratio of it in general anesthesia is greater than conventional tracheal intubation in some countries and regions. With the continuous improvement of LMA, it almost can replace endotracheal intubation.