欧普乐喉罩在侧卧位全身麻醉手术中的临床应用

Clinical application of OPLAC laryngeal mask in lateral general anesthetic operation

[摘要]目的观察欧普乐喉罩在下肢侧卧位患者全麻术中气道管理的安全性和有效性。方法选取2013年1～10月，内江市第一人民医院行全身麻醉侧卧位手术患者40例，随机分为欧普乐喉罩组（O组，20例）和气管插管组（T组，20例）。麻醉诱导插管后，观察指标：心率（HR）、平均动脉压（MAP）、脉搏氧饱和度（SPO2）、分钟通气量（MV）、潮气量（VT）、气道峰压（P融）、呼吸末二氧化碳分压（PETCO2）等；记录O组插入喉罩1次成功率、2次成功率及完成操作时间，平卧位及侧卧位呼吸道密封压（PTOP）；两组拔管期的不良反应及术后并发症。结果O组插入喉罩1次成功率为88％，2次成功率为100％，完成操作时间最短9S，最长126S，平均（28±13）s；O组插管期及拔管期的HR、MBP均较T组降低，T组插管期及拔管期的HR、MBP均明显高于诱导前，差异均有统计学意义（P〈0．05）；平卧位PTOP为（32．58±1．23）cmH20，侧卧位PTOP为（29．17±1．08）cmH20，差异无统计学意义（P〈0．05）；两组MV、VT、Ppeak、SP02、PETCO2比较，差异无统计学意义（P〉0．05）。T组拔管期躁动、呛咳及咽痛发生率明显高于O组，差异有高度统计学意义（P〈0．01）；声嘶、口腔黏膜损伤两组比较，差异无统计学意义（P〉0．05）。两组均无反流误吸和喉痉挛。结论侧卧位全麻手术中欧普乐喉罩可以达到和气管插管同样满意的通气效果，安全可靠；欧普乐喉罩组插管期及拔管期心血管应激反应更小，拔管期呛咳发生率更少。

Objective To observe the safety and effectivity of OPLAC laryngeal mask during general anesthsia apply in lateral general anesthetic operation. Methods From January to October 2013, 40 patients in the First People＇s Hospital of Neijiang city, underwent lateral general anesthetic operation, were randomly divided into OPLAC laryngeal mask group （group O, 20 cases） and tracheal intubation group （group T, 20 cases）. After intubation, the heart rate （HR）, mean arterial pressure （MAP）, minute ventilation （MV）, tidal volume （TV）, peak airway pressure （Ppeak）, pulse oxygen satura- tion （SPO2）, end-tidal CO2 partial pressure （PrrCO2） were observed in two groups. The once success rate, twice success rate, completion time, respiratory tract sealing pressure in lateral position and horizontal position （PToe） were recorded in group O. The adverse reaction during the extubation and the postoperative complication were observed in two groups. Results In group O, the once success rate of OPLAC laryngeal mask insertion was 88%, twice success rate was 100%, the longest completion time was 126 s, the shortest time was 9 s, the average time was （28±13） s; HR and MAP during intubation and extubation of group O were significantly decreased than those of group T, HR and MAP during intuba- tion and extubation in group T were significantly increased than those before the induction, the differences were statis- tically significant （P 〈 0.05）. The PTOP under horizontal position was （32.58±1.23） cm Ha0, under lateral position was （29.17±1.08） cm H20, the difference was not statistically significant （P 〉 0.05）. The MV, VT, Ppeak, SPO2, PETCO2 were no statistical differences between the two groups （P 〉 0.05）. The incidence rate of restlessness, bucking and pharyngo- dynia in group T were significant increased than group O, the differences were statistically significant （P 〈 0.01）, the hoarseness and mouth mucosa injury were no statistically significant different （P 〉 0.05） .There was no single case of regurgitation, aspiration and laryngeal spasm in two group. Conclusion The OPLAC laryngeal mask intubation can pro- vide the same safe and effective ventilation as tracheal intubation in lateral general anesthetic operation under positive ventilation. OPLAC laryngeal mask is suoerior to tracheal intubation in insertion response and coughing response.