SLIPA喉罩用于肥胖患者平卧位全麻手术中气道管理的效果

Clinical effectiveness of SLIPA laryngeal mask airway for obese patients undergoing general anesthesia in supine position

目的 观察SLIPA喉罩用于肥胖患者平卧位全麻手术中气道管理的效果。方法 选择择期全麻手术患者BMI〉30kg/m2 60例,年龄18~65岁。随机均分为两组：SLIPA喉罩组（S组）和气管插管组（T组）。记录插管时间、插入次数、成功率、拔管时间、苏醒时间;观察入室后、插管前、插管即刻、拔管前、拔管即刻HR、SBP、DBP、SpO2、气道峰压（Ppeak）、PETCO2及反流、呛咳及术后1h咽喉部不良反应发生情况。结果 与入室后比较,插管前两组SBP、DBP明显降低,HR明显减慢（P〈0.05）。与插管前比较,插管即刻T组SBP、DBP明显升高,HR明显增快（P〈0.05）。与拔管前比较,拔管即刻T组SBP、DBP明显升高,HR明显增快（P〈0.05）。与T组比较,插管即刻、拔管即刻S组SBP、DBP明显降低,HR明显减慢（P〈0.05）。两组SpO2、Ppeak、PETCO2均在正常范围。T组一次插管22例（73.3%）,二次插管3例（10%）,改用光棒插管5例（16.7%）;S组一次插入喉罩27例（90%）,二次插入喉罩3例（10%）,明显高于T组（P〈0.05）。S组插入时间（12.1±4.2）s,明显短于T组（52.4±11.2）s（P〈0.01）。苏醒期S组无一例患者发生呛咳,明显低于T组11例（36.7%）（P〈0.01）。两组术后1h咽喉部疼痛发生率差异无统计学意义。两组均未发生反流不良反应。结论 肥胖患者全麻手术中SLIPA喉罩与气管插管通气效果相同,但插管期和拔管期应激反应更小,不良反应少,操作简便快捷。SLIPA喉罩用于肥胖患者是安全有效的。

Objective To evaluate the efficacy of SLIPA laryngeal mask airway （SLIPA） on airway management for obeSe patients undergoing general anesthesia in supine position. Methods Six- ty patients, aged 18-65 years with BMI〉30 kg/m2 undergoing general anesthesia, were randomly di- vided into 2 groups （n=30 each） ： SLIPA group （group S） and tracheal tube group （group T）. The duration of anesthesia intubation, placement time, the success rate of the first attempt, the duration of extubation, and anesthesia emergence were recorded. HR, SBP, DBP, SpO2, peak airway pres- sure （Ppeak） and PETCO2 were monitored during anesthesia. The complications after extubation was also observed, such as reflux or aspiration, coughing, sore throat at the time of one hour postopera- tion. Results Compared with entering room, SBP, DBP, HR were significantly decreased before in- tubation in two groups（P〈0. 05）. SBP, DBP, HR were significantly increased at intubation Com- pared to before intubation and at extubation Compared to before extubation in group T （P〈0. 05）. Compared with group T, SBP, DBP, HR were significantly decreased at intubation and extubation in group S （P〈0. 05）. SpO2, Ppeak and PETCO2 were in normal range in two groups. Intubation by 1 time has 22 cases （73.3%）, by 2 times has 3 cases （10%）, using lightwand guided intubation has 5 cases （16.7%）. Laryngeal mask insertion by 1 time has 27 cases （90%）, by 2 times has 3 cases （10%）, group T was significantly lower than group S （P〈0.05）. The insertion time of group S （12. 1 ± 4.2）s was significantly shorter than that in group T （52.4 ±11.2） s （P〈0. 01）. There was no patient coughing in group S compared with 11 cases （36.7%） in group T（P〈0. 05）. Inci- dence of throat pain 1 h after operation in two groups has no statistical significance. None of reflux happened in either group. Conclusion SLIPA masks can provide the same effective ventilation as the tracheal intubation. For its lower cardiovascular reaction and less side effects intra-or post-operative complications and conveniently application, SLIPA masks can be safely and effectively used in obese patients undergoing general anesthesia.