胆囊微创手术患者气道管理的效果

Efficacy of laryngeal mask airway I-gel for airway management in patients undergoing laparoscopic cholecystectomy

目的:探讨I-gel喉罩于术前经鼻置入胃管对胆囊微创手术患者气道管理效果.方法:将87例行腹腔镜胆囊切除术患者,随机分为3组:Ⅰ组(n=29)经喉罩引流管置入胃管;Ⅱ组(n=29)术前经鼻置入胃管且术中保留,放置I-gel喉罩后不经引流管置入胃管;Ⅲ组(n=29)术前经鼻置入胃管且术中保留,放置I-ge l后经引流管置入胃管.术中记录麻醉与手术时间、苏醒时间、胃管引流情况、喉罩置入与拔除情况,以及术后24 h内不良反应.喉罩置入成功后测定纤维支气管镜检查评分、气道密封压,以及喉罩尖端、罩体腹侧、背侧的pH值.结果:3组置入时间、置入刻度、首次置入成功率、气道密封压、拔除时间、气道峰压、喉罩漏气发生率差异无统计学意义(P>0.05).Ⅰ组(25.3 cmH2O±4.7 cmH2O vs28.1 cmH2O±5.6 cmH2O)、Ⅱ组(24.6 cmH2O±3.8 cmH2O vs 29.2 cmH2O±5.8 cmH2O)、Ⅲ组(24.3 cmH2O±3.1 cmH2O vs 30.4 cmH2O±6.2 cmH2O)的气道峰压均低于气道密封压(P<0.05).3组患者血流动力学平稳,其纤维支气管镜检查评分、不良反应的发生率差异无统计学意义,且术后喉罩尖端、罩体的背侧与腹侧的pH值差异均无统计学意义(P>0.05).结论:胆囊微创手术患者于术前经鼻置入胃管时,I-gel喉罩置入较易,其气道密封性可靠,通气效果良好,气道管理安全有效.

AIM： To evaluate the efficacy of laryngeal mask airway I-gel for airway management in patients who underwent insertion of a nasogastric tube before laparoscopic cholecystectomy. METHODS： Eighty-seven patients who would undergo laparoscopic surgery were randomly divided into three groups： I, II and III （n = 29 each）. Group I underwent insertion of a nasogastric tube through the drain tube of laryngeal mask airway I-gel; group II underwent insertion of a nasogastric tube through the nostril before surgery, retained the nasogastric tube during surgery, and then underwent insertion of a nasogastric tube not through the drain tube after placing laryngeal mask airway I-gel; group III underwent insertion of a nasogastric tube through the nostril before surgery, retained the nasogastric tube during surgery, and then underwent insertion of a nasogastric tube through the drain tube after placing laryngeal mask airway I-gel. The anesthesia time, operative time, recovery time, laryngeal mask airway placement time, success rate of laryngeal mask airway placement at the first attempt, depth of placement, the time to laryngeal mask airway removal, bloodstains, gastroesophageal reflux and adverse reactions within 24 h after surgery were recorded. The fiberoptic laryngoscopy score, airway sealing pressure, and pH values at the tip of laryngeal mask airway and on the dorsal and ventral sides of the body of laryngeal mask airway were assessed after successful laryngeal mask airway placement. RESULTS： The laryngeal mask airway placement time, depth of placement, success rate of laryngeal mask airway placement at the first attempt, airway sealing pressure, peak airway pressure, the time to laryngeal mask airway removal, and leakage of laryngeal mask airway showed no significant differences among the three groups （P 〉 0.05）. The peak airway pressures in group I （25.3 cmH2O ± 4.7 cmH2O vs 28.1 cmH2O ± 5.6 cmH2O）, group II （24.6 cmH2O ± 3.8 cmH2O vs 29.2 cmH2O ± 5.8 cmH2O）, and group III （24.3 cmH2O ± 3.1 cmH2O vs 30.4 cmH2O ± 6.2 cmH2O） were significantly lower than airway sealing pressure （P 〈 0.05）. There were no differences in mean arterial pressure, saturation of pulse oximetry or heart rate before and after placing laryngeal mask airway among the three groups （P 〉 0.05）..The scores of fiberoptic laryngoscopy among the three groups did not differ significantly （P 〉 0.05）. The rates of bloodstains, gastroesophageal reflux, pharyngalgia, and hoarseness among the three groups also showed no significant differences （P 〉 0.05）. The pH values at the tip of laryngeal mask airway and on the dorsal and ventral sides of the body of laryngeal mask airway among the three groups also showed no significant differences （P 〉 0.05）. CONCLUSION： When patients undergo insertion of a nasogastric tube before laparoscopic cholecystectomy, insertion of laryngeal mask airway I-gel is easy, and laryngeal mask airway I-gel can assure a good airway sealing and adequate ventilation. The airway management using laryngeal mask airway I-gel is secure and efficient.