I-gel喉罩与Supreme喉罩在腹腔镜肾脏手术中的应用比较

Comparison of I-gel laryngeal mask and Supreme laryngeal mask in patients undergoing laparoscopic renal surgery

目的比较I-gel喉罩与Supreme喉罩在侧卧位腹腔镜肾脏手术中的应用效果。方法静脉全麻下侧卧位腹腔镜肾脏手术患者80例,随机均分为两组,分别使用I-gel喉罩(I组)和Supreme喉罩(S组)通气。记录首次插入成功率、插入时间、平卧位和侧卧位纤维支气管镜检查评级情况以及手术时间、苏醒时间、拔除喉罩时间;记录麻醉前(T1)、喉罩插入成功后5min(T2)、侧卧位后5min(T3)、气腹建立后20min(T4)、术毕时(T5)的气道峰压(Ppeak)及气道密封压(Pleak);记录患者咽喉部损伤情况。结果 I组中喉罩首次插入成功率为92.5%,明显高于S组的72.5%(P<0.05);I组插入时间为(0.8±0.4)min,明显短于S组的(1.4±0.6)min(P<0.05);I组纤维支气管镜评级优于S组(P<0.05),S组平卧位时纤维支气管镜评级优于侧卧位(P<0.05),I组Pleak明显高于S组(P<0.05)。术毕时I组咽喉部疼痛发生率明显低于S组(P<0.05)。结论 I-gel喉罩和Supreme喉罩用于侧卧位腹腔镜肾脏手术麻醉中均可有效通气,前者具有插入更方便快捷、插入成功率高、不需气囊充气、气道密封好及损伤小等优点。

Objective To compare the effect of the I-gel laryngeal mask and the Supreme laryngeal mask in patients undergoing laparoscopic renal surgery. Methods Eighty patients undergoing laparoscopic renal surgery were randomly allocated into 2 groups （n= 40 each）： LMA i-gel group （group I） and LMA Supreme group （group S）. Achievement ratio of first time insertion, inserting time, classification by fiberoptic bronchoscope in supine and lateral position, surgical time, awake time and extubation time were recorded. The peak airway pressure （Ppeak） and airway sealing pressure （Pleak） were monitored before anesthesia （T1）, 5 rain after insertion （T2）, 5min after lateral position （T3）, 20 min after pneumoperitoneum （T4） and at the end of surgery （T5）. Extubation and postoperative complications including blood stain, sore throat and hoarseness were recorded. Results Compared with group S, the achievement ratio （72.5% vs 92.5%）, and classification were higher and the inserting time [-（1.4±0. 6） min vs （0.8±0. 4） min]was shorter in group I （P〈0. 05）. In group S, the classification of supine position was higher than that of lateral position （P〈0.05）. The Pleak in group I was higher than that in group S （P〈0.05）. The incidence of sore throat in the group I was lower than that in group S when the end of surgery （P〈0. 05）. Conclusion The application of the I- gel laryngeal mask and the Supreme laryngeal mask in patients both provided adequate ventilation dur- ing laparoscopic renal surgery. The former was preferentially recommended for its higher ratio of first time insertion with less side effects.