LMA-Supreme喉罩对腹腔镜胆囊切除术患者呼吸功能的影响

Safety evaluation of LMA-supreme laryngeal mask airway used in laparoscopic cholecystectomy

目的比较LMA-Supreme喉罩与气管插管在腹腔镜胆囊切除术(LC)中对患者呼吸功能的影响。方法择期全麻下LC患者80例,随机分为两组,在麻醉诱导后分别采用喉罩(S组)和气管插管(T组)行机械通气,成功后S组经引流孔放入胃管,T组常规经鼻置入胃管。记录气腹前和气腹后10、30min的PETCO2、气道平台压(Pplat)、气道峰压(Ppeak)和肺顺应性(CL),并记录术后不良反应发生情况。结果气腹后10、30min,S组CL明显高于T组,Pplat、Ppeak明显低于T组(P<0.05)。与气腹前比较,气腹后10、30min,两组CL明显降低,PETCO2、Pplat、Ppeak明显升高(P<0.01)。S组术后咽喉痛和呛咳的例数明显少于T组(P<0.05)。结论与气管插管相比,LC术中采用LMA-Supreme喉罩通气更安全,不良反应更少。

Objective To compare the influence on anesthesia and respiratory function in patients using laryngeal mask or tracheal intubation under general anesthesia in laparoscopic cholecystectomy （LC）. Methods Eighty patients undergoing elective laparoscopic cholecystectomy surgery were randomly divided to 2 groups（n--40 each） ： laryngeal mask group（group S） and tracheal intubation group（group T）. In group S laryngeal mask was inserted after induction of anesthesia, a gastric tube was inserted through the drain tube of laryngeal mask. In group T tracheal intubation was inserted after induction of anesthesia, a gastric tube was inserted through nasal cavity. Anesthesia during surgery was maintained by intravenous medication and mechanical ventilation. PETCO2, Pplat, Ppeak, lung compliance （at 3 time points： before pneumoperitoneum, 10 minutes, 30 minutes after Pneumoperitoneum） and complications （sore throat, hoarse voice, bucking, nausea and vomitting） were recorded. Results Before pneumoperitoneum, there was no significant difference of airway resistance between group S and group T. After pneumoperitoneum, the decrease of airway resistance was observed in group S compared with group T（P〈0.05）. Less complications was observed in group S compared with group T（P〈0.05）. Conclusion Compared with tracheal intubation, Supreme laryngeal mask ventilation is safe and effective during laparoscopic cholecystectomy.