腹腔镜腹壁切口疝修补术麻醉中喉罩通气的可行性

Application of proseal laryngeal mask airway for mechanical ventilation under general anesthesia during laparoscopic abdominal incisional hernia repair

目的探讨食管引流型喉罩用于腹腔镜腹壁切口疝修补术麻醉中通气的可行性。方法择期全身麻醉下行腹腔镜腹壁切口疝修补术患者60例,年龄24～82岁,ASAⅠ或Ⅱ级,随机分为喉罩（LMA）组和气管导管（ETT）组,每组30例。术中采用压力控制通气（pressure controlled ventilation,PCV）模式,记录患者全身麻醉诱导后气管导管/喉罩置入前与置入完成后即刻及气管导管/喉罩拔出前及拔出后即刻患者平均动脉压（MAP）及心率（HR）,RR为12次/min、I/E为1∶1.5条件下使实际潮气量（VTE）达到7 ml/kg时的预设吸气峰压（Pinspired）值以及术中胃肠减压引流瓶容量的增加。结果所有患者气管导管或喉罩置入顺利且能够满足手术通气要求。气管导管/喉罩置入后及拔出后即刻ETT组的MAP及HR明显高于LMA组（t=6.927、2.471、4.033、3.185,P=0.000、0.016、0.000、0.002）,气管导管/喉罩置入后与置入前即刻及拔出后与拔出前比较仅ETT组MAP及HR明显增加（t=2.916、2.965、2.171、2.484,P=0.026、0.016、0.000、0.025）;PCV模式下RR为12次/min、I/E为1∶1.5条件下,当VTE达到7 ml/kg时LMA组Pinspired值明显低于ETT组（t=3.046,P=0.004）;二组患者术中胃肠减压引流瓶容量的增加无明显差异;术后24 h时咽喉疼痛不适发生率LMA组明显低于ETT组（χ2=4.32;P=0.038）。结论食管引流型喉罩较气管导管对循环影响小,通气可靠,术后并发症发生率低,可满足腹腔镜腹壁切口疝修补术麻醉的通气需要。

Objective To investigate the feasibility of Proseal Laryngeal Mask Airway（ PLMA）instead of endotracheal intubation（ ETT） for mechanical ventilation during laparoscopic abdominal incisional hernia repair. Methods Sixty ASA class Ⅰ or Ⅱ patients aged 24 to 82 years undergoing laparoscopic abdominal incisional hernia repair under general anesthesia were enrolled in this study. The patients were randomized to receive either PLMA（ n = 30） or endotracheal tube（ ETT）（ n = 30）,and pressure-controlled ventilation（ PCV） mode was used in both groups during general anesthesia. MAP and HR were recorded right before and after insertion and removal of LMA or ETT. Inspiratory pressure（ Pinspired） was measured when expiratory tidal volume（ VTE） was controlled at 7 ml / kg,respiratory rate（ RR） at 12 times / minute and inspiratory to expiratory ratio（ I / E） at 1∶ 1. 5. The increment of negative pressure drainage from gastric tube in capacity during the surgery was also measured. Results LMA / endotracheal tube successfully inserted and met the requirements of positive pressure ventilation during the operation in all the patients. The changes in MAP and HR as insertion or removal of LMA / endotracheal tube were less in the LMA group.Pinspired was lower in the LMA group（ t = 3. 046,P = 0. 004） and there was no significant difference in the increment of negative pressure drainage from gastric tube in capacity between the two groups. Significantly less patients complained about sore throat in the LMA group at 24 hours after surgery（ χ2= 4. 32,P =0. 038）. Conclusion PLMA is superior to endotracheal intubation in terms of more stable status of circulation during surgery,efficacy of mechanical ventilation and fewer postoperative complications. PLMA can meet the mechanical ventilation under general anesthesia during laparoscopic abdominal incisional hernia repair.