Guardian喉罩在腹腔镜成人腹股沟疝修补术全身麻醉中的应用

Application of laryngeal mask airway Guardian for ventilation under general anesthesia during laparoscopic inguinal herniorrhaphy for adult patients

目的观察Guardian食管引流型喉罩用于成人腹腔镜腹股沟疝修补术全身麻醉中的安全性和优越性。方法回顾性分析首都医科大学附属北京朝阳医院京西院区2011年9月至2012年7月368例全身麻醉腹腔镜下行单纯腹股沟疝修补手术患者的临床资料,其中气管内插管全身麻醉患者59例(ETT组),放置Guardian喉罩全身麻醉患者309例(LMA组),比较二组患者在不同时点的循环指标、通气指标变化情况及术后声音嘶哑、咽喉痛、吞咽困难等不良反应发生率。结果所有患者气管插管或喉罩置入顺利。气管插管和喉罩置入及拔出时ETT组平均动脉压(MAP)及心率(HR)明显高于LMA组(t=12.744、15.944、6.477、15.158,P均>0.05),术中腹膜关闭时二组患者MAP、HR及呼气末二氧化碳(PETCO2)差异无统计学意义(t=1.521、1.639、1.059,P均>0.05);全身麻醉苏醒期LMA组患者因血压过高而采取降压措施的发生率明显低于ETT组(χ2=13.049,P=0.000)。LMA组术后6h时声音嘶哑和咽喉疼痛发生率及24h时声音嘶哑发生率明显低于ETT组(χ2=11.826、14.622、46.497,P均<0.05),而二组患者术后6h及24h吞咽困难的发生率差异无统计学意义(χ2=0.349、0.000,P均>0.05)。结论 Guardian喉罩可以满足腹腔镜腹股沟疝修补术全身麻醉中的通气要求,且麻醉过程中循环更平稳,术后不良反应发生率低,更具优越性。

Objective To observe the effectiveness and superiority of laryngeal mask airway Guardian （GLMA） for ventilation under general anesthesia during laparoscopic inguinal herniorrhaphy for adult patients. Methods Clinical data of 368 cases of laparoscopic inguinal herniorrhaphy under general anesthesia for adult patients from September 2011 to July 2012 were retrospectively analyzed. There were 59 cases of endotracheal intubation （ group ETY） for mechanical ventilation and 309 cases of laryngeal mask airway Guardian （ group LMA）. Mean arterial pressure （ MAP）, heart rate （ HR）, PETC02 of different time and postoperative complications were compared between different the groups. Results Insertion was performed successfully in all the patients. The MAP and HR were significantly higher in the group ETI＂ than in the group LMA when the endotracheal tube or laryngeal mask was inserted or removed（ t = 12. 744, 15. 944,6. 477,15. 158,P all 〉0.05）. There was no significant difference between the two groups in the MAP, HR and PETCO2 when the closure of peritoneum was completed （t = 1. 521,1. 639,1. 059 ,P all 〉 0.05）. The incidence rate of antihypertensive treatment in the group ETI＂ was significantly higher than in group LMA in the recovery period of general anesthesia （X^2 = 13. 049,P =0. 000）. The incidence rates of hoarseness and sore throat in the group LMA were significantly less than in the group ETT at 6 h and 24 h after surgery（X^2 = 11. 826,14. 622,46. 497, P all 〈 0.05 ） ; however, there was no significant difference between the two groups in dysphagia （X^2 = 0. 349,0. 000, P all 〉 0.05 ）. Conclusions GLMA can successfully meet the demands of mechanical ventilation under general anesthesia during laparoscopic inguinal herniorrhaphy for adult patients. GLMA is superior to endotracheal intubation due to fewer complications and more stable status of circulation during the operation.