双腔Supreme喉罩对妇科腹腔镜手术患者循环和通气功能的影响

Effects of Supreme laryngeal mask airway on circulation and ventilation in patients underwent gynaecological laparoscopic operation

目的比较双腔Supreme喉罩和气管插管对妇科腹腔镜手术患者血流动力学和通气功能的影响。方法择期行妇科腹腔镜手术者80例，ASAI～Ⅱ级。随机分为两组，即喉罩组（LMA组，40例）和气管插管组（ET组，40例）。比较两组患者麻醉诱导前（TO）、诱导后（T1）、插入喉罩／气管导管后即刻（T2）及插入喉罩／气管导管后3rain（T3）、拔管前（．r4）、拔管即刻（T5）、拔管后3min（rr6）患者的平均动脉压（MAP）、心率（HR）、脉搏血氧饱和度（SpO：）；记录间歇正压通气5rnin（T7）、15min（I＂8）、30min（T9）的分钟通气量（MV）、气道峰压（Ppeak）、潮气量（VT）和呼气末二氧化碳分压（P。，CO：）；同时记录低氧血症、呛咳、恶心呕吐、声音嘶哑、咽喉痛、反流误吸等不良反应。结果LMA组、ET组T1时MAP显著低于110时（P〈0．05）；组间比较T2、仍、T5、T6时点ET组的MAP和HR显著高于LMA组（P〈0．05）；其他时点两组MAP、HR比较差异无统计学意义；SpO：均维持在95％～100％。两组17～T8时点MV、VT、PM、CO：、Ppeak比较差异无统计学意义，1、9时点PETC02、Ppeak喉罩组高于气管插管组；Supreme喉罩组的不良反应低于气管插管组。结论Supreme喉罩可安全用于妇科腹腔镜手术患者，通气可靠，对血流动力学影响轻微，并且不良反应发生率低。

Objective To compare the effects of supreme laryngeal mask airway（LMA） and en- dotracheal intubation （ET） on hemodynamics and respiratory function in patients underwent laparoscopic cholecystectomy. Methods Eighty patients （ ASA class I or II ）, scheduled for laparoscopic cholecystec- tomy under general anesthesia were randomly divided into LMA group （n = 40） and ET group （n = 40） with mechanical ventilation. MAP, HR and SpO2 were recorded before anesthesia induction（T0）, before intubation （ T1 ）, after intubation immediately （ T2）, 3 rain after intubation （ T3 ）, before extubation （ T4 ）, after extubation immediately（ T5 ）, 3 min after extubation（T6）. The tidal volume （VT）, minute vential- tion （ MV ）, peak inspiratory pressure （Ppeak） and PET CO2 were recorded at 5 min （ T7 ）, ! 5 min （ T8 ）, 30 rain（T9） of deflation. And the adverse reactions such as hypoxemia, cough, nausea and vomiting, hoarseness, sore throat, regurgitation and aspiration were recorded. Results MAP in LMA and ET group at T1 was significantly lower than those at TO. In group ET, HR and MAP were significantly higher than those in group LMA at T2, T3, TS, T6 （ P 〈 0. 05）. There was no significant difference in VT, MV, Ppeak or P^TCO2 between the two groups at T7 ,T8（ P 〉0.05）. Ppeak and PETCO2 in group LMA were significantly higher than those in group ET. The icidences of adverse reactions were lower. Conclu- sions Ventilation with LMA in patients underwent laparoscopic cholecystectomy is effective for mechani- cal ventilation, with simpler operation and mild cardiovascular adverse response.