LMAsupreme^TM喉罩与气管插管静脉全麻在腹腔镜直肠癌切除手术中的应用

Application of LMA supreme^TM and Tracheal Tubes Undergoing Rectal Cancer Surgery

目的：探讨LMAsupreme ^TM喉罩和气管插管静脉全麻两种方法用于腹腔镜直肠癌切除手术时对患者血流动力学、呼吸参数变化及术中术后不良反应发生率的影响，评估LMAsupreme^TM喉罩在腹腔镜直肠癌切除术中应用的安全性及优越性。方法：选择腹腔镜直肠癌切除手术患者40例，ASAⅠ～Ⅱ级，随机分成2组，即LMAsupreme^TM喉罩组（s组）和气管插管组（T组），每组20例。麻醉诱导后分别插入LMAsupreme^TM喉罩和气管插管，记录并比较两组在麻醉诱导前、喉罩和气管导管插入前即刻及插入后即刻、1min和5min时收缩压（SBP）、舒张压（DBP）、心率（HR）。记录建立二氧化碳（CO2）气腹前、后和体位改变后气道平台压（Pplat）、气道峰压（Ppeak）；观察手术过程中返流误吸、术后声嘶、咽痛、呛咳不良反应。结果：与T组比较，S组血流动力学平稳（P〈0．05），呼吸参数稳定变化小（P〈0．05），术中发生返流误吸无统计学差异，术后声嘶、咽痛、呛咳显著减少（P〈0．05）。结论：LMAsupremeTM喉罩在腹腔镜直肠癌切除术中应用能达到与气管导管同样的通气效果，对麻醉过程中血流动力学、呼吸参数影响更小，术中术后不良反应显著减少，且操作简单、易学，与气管插管方法相比在临床应用有更好的安全性及优越性。

Objective：To investigate the variations of hemodynamics or respiratory parameters and post- operative complication incidence in laparoscopic rectal cancer surgery to perform the supreme LMA and Tracheal Tubes and to assess the safety or superiority. Methods： Forty ASA Ⅰ-Ⅱrade patients underwent rectal cancer surgery were randomly divided into two groups： Supreme LMA group（ S）, Tracheal Tube group （T）. Patients were intubated with supreme LMA, Tracheal Tube respectively after general anesthesia was induced with mid- azolam 0.05 mg/kg, fentanyl 2 μg/kg, etomidate 0.3 mg/kg and vecuronium 0.1 mg/kg. Record and count baseline or variable valus on systonic pressure, dystonic pressure, heart rate, peak inspiration pressure, fiat in- spiration pressure as pre - and post - pneumoperitoneum, head down tilt. To observe intra - and post - opera- tion complication on backflow or aspiration, pharyngodynia, trachyphonia, irritating cough. Results：The hemo- dynamic during intubation and respiratory parameters were more stable in group S than in group T （ P 〈 0.05 ）. There were no differences on backflow or aspiration during intraoperation between two groups. Postoperation in- cidences were significantly lower in group S than group T on trachyphonia, pharyngalgia or bucking（ P 〈 0.05 ）. Conclusions：LMA supremeTMventilation is effective as well as tracheal tube in rectal cancer surgery. It impacts little variations of hemodynamics or respiratory parameters after general anesthesia and reduces incidence of complications significantly compared with T group. In addition, the method is simple. LMA supremeTM is safer and superior to tracheal tubes on clinical applications.