Proseal、Supreme和I-gel三种双管喉罩用于妇科腹腔镜麻醉的气道管理比较

Effect Comparison on Laryngeal Mask Airway of Proseal,Supreme( SLMA) and Ⅰ-gel during Gynecological Laparoscopic Surgery

目的比较Proseal喉罩、Supreme喉罩和I-gel喉罩用于妇科腹腔镜麻醉的实用性和安全性。方法 120例妇科腹腔镜择期手术患者随机分成三组,每组40例,分别置入Proseal喉罩(P组)、Supreme喉罩组(S组)和I-gel喉罩组(I组)。记录三种喉罩置入操作的时间与成功率、肺通气情况、口咽部漏气压(oropharyngeal leak pressure,OLP)、纤维支气管镜检查喉罩对位情况、气道峰压(Ppeak)、胃胀气情况、反流、拔管情况和术后有无咽痛。结果三组患者首次置入成功率在92.5%以上,二次置入成功率为100%。三组准备时间(T0)比较,I组明显短于P组(P<0.01)和S组(P<0.05);而置入时间(T1)比较,P组明显长于S组和I组(P<0.01)。设置通气罩内压(intracuff pressure,ICP)在60 cm H2O(ICP/60)时P组OLP明显优于S组(ICP/60)和I组(P<0.05)。术后24 h随访咽痛患者S组明显多于P组(P<0.05)和I组(P<0.01)。结论三种双管喉罩可安全有效用于妇科腹腔镜手术患者全麻时的气道管理,Supreme喉罩、I-gel喉罩一次性使用,操作更便捷,如麻醉需要较高气道密封性,则Proseal喉罩更适合。

Objective To compare the efficacy and safety of Proseal,Supreme and I-gel laryngeal mask airway（ LMA） in gynecological laparoscopic surgery. Methods A total of 120 women were randomly divided into three groups,40 cases for each,and were intubated laryngeal mask of Proseal（ as group P）,Supreme（ as group S） and I-gel（ as group 1） respectively. The placement time and the successful rate of LMA,pulmonary ventilation,oropharyngeal leak pressure（ OLP）,counterpoint of fiberoptic bronchoscopy,peak airway pressure（ Ppeak）,gastric distention,regurgitation,complications of extubation and pharyngalgia after surgery were recorded and compared among three groups. Results The success rates of LMA placement was above 92. 5%at first time and reached 100% at second time in all the three groups. The preparation time（ T0） of group I was obviously shorter than that of group P（ P〈 0. 01） and group S（ P〈 0. 05）. The insertion time（ T1） of group S and group I were remarkable faster than that of group P（ P〈 0. 01）. When the intracuff pressure（ ICP） was kept at 60 cm H20,the OLP of group P was obviously better than that of group S and group I（ P〈 0. 05）. The postoperative adverse event incidence of pharyngodynia in group S was higher than that in both group P（ P〈 0. 05） and group I（ P〈 0. 01）. Conclusions All the three airway devices can be safe and effective in airway management during gynecological laparoscopic surgery. The Supreme and I-gel can achieve more convenient and quicker intubation with single-use,however Proseal can obtain a better airway sealing.