喉罩与气管插管在腹腔镜胆囊切除术中对血流动力学的影响

Compared haemodynamics effects of laryngeal mask airway and tracheal intubation in patients undergoing laparoscopic cholecystectomy

目的比较喉罩（LMA）与气管插管用于全身麻醉腹腔镜胆囊切除术（Lc）患者血流动力学的影响。方法选择胆石症患者60例，随机分为喉罩组（A组）和气管插管组（B组）。全身麻醉诱导咪唑0．1mg／kg，舒芬太尼0．2斗∥kg，异丙酚2mg／kg，阿曲库铵0．15mg／kg，静脉给药。通气设置为潮气量6～8ml／kg，频率12～14次／min，间歇正压通气（IPPV），C02气腹（压力〈12mmHg，1mmHg=0．133kPa）。记录两组在诱导前（T0），插喉罩或气管导管后3rain（T1），气腹后（T2），拔喉罩或气管导管前3min（T3）及拔喉罩或气管导管后3min（T4）时的收缩压（SBP）、舒张压（DBP）、心率（HR）及术后并发症。结果在诱导期，苏醒期血流动力学变化喉罩组较气管插管组小，术后并发症喉罩组较气管插管组少。结论喉罩用于Lc全身麻醉患者应激反应轻，血流动力学反应小于气管插管，并能有效通气，术后咽部并发症少，需要减少诱导药物用量。

Objective To compare the haemodynamics effects of laryngeal mask airway （LMA） and tracheal intubation in patients undergoing laparoscopic cholecystectomy （LC）. Methods Sixty pa-tients with eholecystolithiasis were divided into two groups： Laryngeal mask airway group （group A） and tracheal intubation group （group B）. Anesthesia induction was performed by intravenous injection with mid- azolam（0. 1 mg/kg） , sulfentanyl（0. 2 tzg/kg）, propofol（2 mg/kg）, atracufium（0. 15 mg/kg）. The pa- rameter of ventilation to be as follow, tidal volume 6 - 8 ml/kg, respiratory frequency 12 - 14 times/rain intermittent positive pressure ventilation （IPPV）, CO2 pneumoperitoneum pressure 〈 12 mm Hg （1 mm Hg = 0. 133 kPa）. SBP, DBP, HR and postoperative complications were recorded before anesthesia induction（To ）, three minutes after LMA or endotraeheal tube insertion （T~）, after pneumoperitoneum （ T： ）, three minutes before departed LMA or endotraeheal tube （ T3 ） and three minutes after departed LMA or endotracheal tube （T4 ）. Results In induced phase, awakening hemodynamic changes of laryngeal mask group was tracheal intubation small group, the postoperative complications of laryngeal mask was tracheal intubation less group. Conclusions Compared with group B, group A offered better general anesthesia on LC for LMA insertion, conduced to degrade stress reaction, more stable haemodynamics effects, beneficial ventilation and reduced dosage. The occurrence of postoperative sore throat is obviously lower in group A.