I-gel喉罩用于全麻剖宫产手术的临床研究

Applicat ion of I-gel laryngeal mask airway in general anesthesia for cesarean section

目的评估I-gel喉罩用于全麻剖宫产手术中气道管理的安全性。方法择期剖宫产全麻患者68例随机分为I-gel喉罩组(I组)和气管插管组(E组),每组34例。记录两组插入喉罩或气管导管所需时间,插喉罩或插管前(T_0)、插喉罩或插管即刻(T_1)、拔喉罩或拔管前(T_2)、拔喉罩或拔管即刻(T_3)的心率(HR)、平均动脉压(MAP),术中脉搏血氧饱和度(SpO_2),气道峰压(Ppeak),喉罩或气管导管拔除时间,拔喉罩或拔管时的呛咳反应,喉罩或气管导管拔出时的染血情况,术后1 h咽喉部疼痛情况,I组测量气道密封压(OLP)。结果 I组喉罩置入和拔除时间明显短于E组气管导管插入和拔除时间(t分别=9.22、12.04,P均<0.05);在T_1、T_3时间点,I组的HR、MAP明显低于E组(t分别=2.09、2.33、2.65、2.30,P均<0.05),E组MAP在T_1、T_3明显高于T_0时间点,差异有统计学意义(t分别=4.96、4.41,P均<0.05)。拔除喉罩或拔管时的呛咳反应,术后1 h咽喉部疼痛情况,I组明显优于E组(χ~2分别=11.51、8.78,P均<0.05);I组所有患者OLP均高于其Ppeak,两组患者无1例发生反流误吸。结论 I-gel喉罩可安全用于剖宫产全麻手术中的气道管理,且不良反应更少。

Objective To evaluate the safety of application of I-gel laryngeal mask airway in general anesthesia for cesarean section operation. Methods Sixty-eight patients who underwent general anesthesia in elective caesarean section were randomlized into I-gel laryngeal mask airway group （group I）and tracheal intubation group （group E） with 34 cases in each. The times of intubating tracheal catheter or the I-gel laryngeal mask airway were recorded. The HR and MAP before intubation （T0）,at intubation （T1）, before extubation （T2）,and at the moment of extubation （T3）were compared. The SpO2,peak airway pressure （Ppeak）,tracheal extubation time,the cough reaction, and blood staining during extubation,throat ache condition at one hour after operation,and the oropharyngeal leakage pressure（OLP）were recorded and measured. Results The time of intubation and extubation of LMA in group I were significantly shorter than the time of intubation and extubation of tracheal catheter in group E （t=9.22,12.04,P〈 0.05）.The HR and MAP of group I were significantly lower than those of group E At T1 and T3 （t=2.09,2.33,2.65,2.30, P〈0.05）.Compared to T0,the MAP of group E at T1 and T3 were significantly lower （t=4.96,4.41 ,P〈0.05）.The cough reaction during extubation and throat ache condition after operation in group I were significantly better than those in group E （X^2=11.51,8.78,P〈0.05）.The OLP of group I was higher than Ppeak parameter. No reflux aspiration was found in all patients. Conclusion I-gel laryngeal mask airway can be used safely in the general anesthesia for caesarean section with less adverse reaction.