Supreme双管喉罩与气管插管在妇科腹腔镜手术麻醉中的比较

Comparison of Supreme Laryngeal Mask Anesthesia and Endotracheal Intubation in Gynecological Laparoscopic Surgery

目的:比较Supreme双管喉罩与气管插管在妇科腹腔镜手术麻醉中的应用效果。方法:择期妇科腹腔镜手术患者60例,按照随机双盲原则分为Supreme双管喉罩组(S组)和气管插管组(T组),经静脉麻醉诱导后,记录两组插入喉罩(导管)成功率、肺通气情况;记录插入前(T_1)、插入即刻(T_2)、插入后2 min(T_3)、拔除喉罩(拔管)前(T_4)、拔除即刻(T_5)、拔除后3 min(T6)的HR、SBP、DBP;监测气道峰压(Pmax)、气道平台压(Pmean)、Sp O2、PETCO2;苏醒期躁动、术后呛咳、咽喉痛、声嘶等并发症。结果:两组患者的年龄、身高、体重、手术时间、麻醉时间、拔管(罩)时间比较,差异均无统计学意义(P>0.05);两组插入成功率均为100%;诱导前后两组SBP、DBP和HR比较,差异均无统计学意义(P>0.05);与T组比较,S组置入喉罩或拨除喉罩后,即在T_2、T_3、T_5、T6时HR较慢,SBP、DBP较低,差异均有统计学意义(P<0.05);两组Pmax、Pmean、PETCO2值各时点比较,差异均无统计学意义(P>0.05);与T组比较,S组苏醒期呛咳、术后声嘶、咽喉痛发生率均较低,差异均有统计学意义(P<0.05);S组胃管放置顺利,成功率为100%,气道密封压(25±4)cm H2O,两组均未发生返流、误吸。结论:妇科腹腔镜手术中Supreme双管喉罩可以达到与气管插管相同的安全有效的通气效果,并且对血流动力学影响小,不良反应少。

Objective：To compare the application effect of Supreme laryngeal mask anesthesia and endotracheal intubation in gynecological laparoscopic surgery.Method：A total of 60 patients undergoing gynecological laparoscopic surgery were randomly divided into Supreme laryngeal mask group（group S） and endotracheal intubation group（group T） according to the random double-blind principle,inserted the laryngeal mask（catheter） in two groups after intravenous anesthesia,the success rate and lung ventilation of two groups were compared.HR,SBP and DBP at six time：before insertion（T_1）,immediate insertion（T_2）,insert after 2 min（T_3）,before removal of laryngeal mask（extubation）（T_4）,extraction immediately（T_5）,after the removal of 3 min（T6） were recored.The peak airway pressure（Pmax）,plateau airway pressure（Pmean）,Sp O2,PETCO2,emergence agitation,postoperative cough,sore throat,hoarseness and other complications of two groups were monitored.Result：The operation time,anesthesia time,inserted（extubation） time of two groups,there were no significant differences（P〉0.05）.The success rate of two groups were 100%.Differences of SBP,DBP and HR before and after anesthesia induction of two groups had no statistic significant（P〉0.05）.Compared with group T,inserted or removed laryngeal mask in group S,in T_2,T_3,T_5,T6 HR was slower,SBP and DBP were lower,the differences were statistically significant（P〈0.05）.The differences of Pmax,Pmean and PETCO2 in all times of two groups had no statistic significant（P〉0.05）.Compared with group T,the emergence agitation,hoarseness postoperative,sore throat of group S were lower incidence rate（P〈0.05）,the difference were statistic significant（P〈0.05）.In group S,the gastric tube placement was successfully,the rate was 100%,the airway sealing pressure was（25±4）cm H2 O,two groups had no regurgitation and aspiration.Conclusion：Laparoscopic surgery in Supreme laryngeal mask and tracheal intubation can reach the same safe and effective ventilation effect,and little effect on hemodynamics,fewer adverse reactions.