SLIPA喉罩和食管引流型喉罩在老年人腹腔镜胆囊切除手术中的应用

Application of the streamlined liner of the pharynx airway and the proseal laryngeal mask airway in elderly patients undergoing laparoscopic cholecystectomy

目的比较（SLIPA）喉罩和食管引流型喉罩（PLMA）用于老年腹腔镜胆囊切除手术患者气道管理的效果。方法拟择期行腹腔镜手术患者120例，年龄60～75岁，美国麻醉医师协会（ASA）分级Ⅰ或Ⅱ级，随机分为3组，每组40例：气管插管组，SLIPA组和PLMA组。麻醉诱导后置入气管导管或喉罩，行间歇正压通气。记录麻醉诱导前（T0）、管（罩）置入成功即刻（T1）、气腹后10min（T2）、拔除时（T1）、拔除后10min（T4）平均动脉压及心率。记录管（罩）置入情况、置入时间、测定气道密封压。记录拔除管（罩）时呛咳、返流、误吸及喉痉挛的发生情况；管（罩）拔除后粘血及胃胀气的发生情况；术后2d内咽痛的置入发生情况。结果气管插管组、SLIPA组、PLMA组1次置入成功率分别为92．5％、92．5％、95．0％（x2=0．268，P〉0．05），2次置入成功率均为100．0％。气管插管组在麻醉诱导后和SLIPA组、PLMA组比较，患者的血流动力学变化有明显差异（t=4．076，P〈0．05）。SLIPA组喉罩置入时间较气管插管组和PLMA组短，喉罩置入容易（t=43．561，P〈0．05）。PLMA组喉罩气道密封压较SLIPA组高，但差异无统计学意义（t=0．363，P〉0．05）。3组患者反流、误吸、喉痉挛和胃胀气的发生率差异无统计学意义（t=0．321，P〉0．05）；SLIPA组和PLMA组呛咳和咽痛的发生率低于气管插管组（分别为x2=26．674，10．568，均P〈0．05）。结论SLIPA和PLMA喉罩均可保证有效通气，不良反应少。SLIPA喉罩置入更简单，而PLMA喉罩气道密封效果较好，更适用于老年腹腔镜胆囊切除手术患者。

Objective To compare the efficacy of the streamlined liner of the pharynx airway （SLIPA） and the proseal laryngeal mask airway （PLMA） in airway management in elderly patients undergoing laparoscopic cholecystectomy. Methods One hundred and twenty patients aged 60-75 years with American Society of Anesthesiologists （ASA） gradeⅠ or Ⅱ undergoing laparoscopic cholecystectomy were randomly divided into three groups： the endotracheal intubation group （Group T,n=40） ,the SLIPA group （Group S,n=40） and the PLMA group （Group P,n=40）. Endotraeheal intubation and laryngeal mask airway insertion were conducted after induction of anesthesia. All the patients were ventilated with intermittent positive pressure ventilation. Mean arterial pressure and heart rate were recorded at before induction （TO）, successful insertion （T1）, ten minutes after pneumoperitoneum （T2）, successful extubation （T3）, and ten minutes after extuhation （T4）. The rate of successful placement at first attempt, time taken for placement, airway sealing pressure, and side effects were recorded. The incidences of post extubation cough, backflow, aspiration, larynogospasm, bleeding, gastric distension and sore throat within 2 days after intubation were also recorded. Results The successful rates of insertion were 92.5%, 92.5%, 95.0%, respectively, at first attempt and 100.0% at second attempt in the three groups （x2 =0. 268, P〈0.05）. Changes in hemodynamic parameters were significantly different between Group T and Group S or P after induction （t=4. 076, P〈0.05）. Time taken for placement was shorter in Group S than in Groups T and P, meaning that the placement of SLIPA was easier than that of endotracheal intubation or PLMA （ t=43. 561, P〈0.05）. The airway sealing pressure was higher in Group P than in Group S, hut had no statistically significant difference between the two groups （t= 0. 363, P〉 0.05）. There was no significant difference in post-extubation complications, including backflow, aspiration, laryngospasm and gastric distension （t= 0. 321, P〉 0.05）, among the three groups, but incidences of post- extubation cough and pharyngalgia were higher in Group T than in Group S and Group P （X2 = 26. 674, 10. 568, P〈0.05）. Conclusions SLIPA and PLMA can both provide adequate ventilation during operation, with few complications. SLIPA placement is the easiest, while PLMA has good airway sealing and thus is more suitable for elderly patients undergoing laparoscopic cholecystectomy.