Supreme喉罩在腹腔镜胆囊切除术中的应用研究

Application of Supreme laryngeal mask airway in laparoscopic cholecystectomy

目的:通过观察Supreme喉罩在腹腔镜胆囊切除术中的应用,探讨其安全性与优越性。方法:择期腹腔镜胆囊切除手术患者60例,ASAⅠ~Ⅱ级,随机均分为喉罩组(S组)和气管插管组(T组)。记录诱导前(T0)﹑插入喉罩/气管导管即刻(T1)﹑插入喉罩/气管导管3min(T2)和拔出喉罩/气管导管前3min(T3)﹑拔出喉罩/气管导管即刻(T4)﹑拔出喉罩/气管导管后3min(T5)的MAP、HR、SpO2、PET CO2;丙泊酚用量﹑苏醒和拔罩/管时间,以及术中胃胀气、反流误吸、术后咽喉部不适等并发症。结果:与T组比较,S组患者在麻醉诱导和苏醒阶段(T1~T4)的HR减慢,MAP降低,血流动力学更加平稳(P<0.05)。S组丙泊酚用量降低,苏醒时间、拔喉罩时间缩短(P<0.05)。S组有2例患者术中气道阻力升高,PET CO2升高至60mmHg。术后咽喉不适S组(2例)明显少于T组(10例)(P<0.05)。结论:与气管插管比较,Supreme喉罩对血流动力学影响小,麻醉用药量减少,苏醒快且并发症少,是一种较为理想的全麻气道管理工具,但术中应监测PET CO2。

Objective：To tomy, and explore its security observe the application of supreme laryngeal mask airway in laparoscopic cholecystec- and advantages. Methods：60 pati ASA I - II level, were randomly divided into two groups, laryngeal mask group （group S） and trachea intubation group（group T）. MAP, HR, SpO2 and PrrCO2 will be recorded before the induction（T0）, at intubating LMA/tube instant- ly（T1）, 3 min after intubating （T2） and 3 min before pulling out LMA/tube （T3）, pulling out instantly （T4）,3 min after pulling out（Ts）. Dosage of propofol, the time of waking up and pulling out LMA/tube were be recorded. And complica- tions, such as intraoperative flatulence, reflux and aspiration postoperative, throat discomfort were also recorded. Re- suits：Compared with, HR, MAP in group S were significantly lower at T1 - T4, and dosage of propofol in group S were lower. Time of waking up and pulling out LMA pressure and P^CO2 of 2 patients increased to in group S were lower than group T（P 〈 0.05）. But intraoperative airway 60 mmHg in group S. Incidence of postoperative throat discomfort in group S （2 cases） was obviously less than group T（10 cases） （P 〈 0.05）. Conclusion：Compared with endotracheal intu- bation, supreme LMA is one of ideal airway management tools, because it can make more stable hemodynamies, re- duce dose of propofol and complications during anesthesia, but PL-rCO2 should be monitored perioperatively.