改良快速顺序诱导联合i-gel喉罩在腹腔镜胆囊切除术中的应用

Application of the modified rapid sequence induction combined with laryngeal mask airway i-gel in laparoscopic gallbladder surgery

目的:观察改良快速顺序诱导联合i-gel喉罩在腹腔镜胆囊切除术(LC)中对患者诱导期血流动力学及手术区视野评级的影响。方法:择期LC患者80例,随机分为改良快速顺序诱导组(M组)和常规快速诱导组(C组)各40例。M组患者采取分次给药、不行人工正压通气的诱导方法,C组患者采取常规静脉快速诱导。2组患者均在麻醉诱导前局麻下行桡动脉穿刺,测直接动脉压,生化监测。2组患者诱导给药速度均为1 ml/s,术中补液速度均为10 ml·kg-1·h-1。记录2组患者麻醉诱导前、麻醉诱导后2 min、喉罩置入后1 min和5 min各时点的心率、平均动脉压、脉搏血氧饱和度、动脉氧分压及动脉二氧化碳分压的变化,并对手术区视野进行评级。结果:在诱导期间M组血流动力学较C组稳定。M组手术区视野评级优良率高于C组(P<0.05)。结论:与常规快速诱导法相比较,M组患者的血流动力学更平稳,无缺氧和二氧化碳蓄积,适用于LC的全麻诱导,且避免了诱导时返流误吸、术中胃肠道积气等并发症,有着良好的临床应用前景。

Objective： To observe the effects of the modified rapid sequence induction combined with laryngeal mask airway（ LMA） igel on the hemodynamics during induction period and surgical site grade in laparoscopic gallbladder surgery. Methods： Eighty laparoscopic cholecystectomy patients scheduled by laparoscopic gallbladder surgery were randomly divided into the modified rapid sequence induction group（ group M） and conventional rapid induction（ group C）（ 40 cases each group）. The group M were induced with gradation dose combined without artificial positive pressure ventilation,the group C were induced with conventionally intravenous way.The arterial pressure and biochemical indexes in two groups were detected by radial artery puncture under local anesthesia before anesthesia induction. The speeds of the injection and transfusion were 1 ml / s and 10 ml·kg^- 1·h^- 1in two groups,respectively. The heart rate,mean arterial pressure,pulse oxygen saturation,arterial blood oxygen partial pressure and arterial blood CO2 partial pressure of two groups were recorded at the time of pre-induction,post-induction 2 min,post-insertion LMA 1min and 5min,and the operation field was rated. Results： Compared with group C during induction,the hemodynamics of group M was stable. The fineness rate of the operation field grade in group M was higher than that in group C（ P〈0. 05）. Conclusions： Compared with the conventional rapid induction,the modified rapid sequence induction is stable hemodynamics and no lack of oxygen and carbon dioxide accumulation,which is suitable for induction in laparoscopic gallbladder surgery,can avoid the reflux,aspiration and gastrointestinal flatulence,and has a good prospect of clinical application.