腹腔镜胆囊手术喉罩全身麻醉3种置入方法比较

Comparison of three methods of inserting laryngeal mask airways during laparoscopic cholecystectomy

目的比较腹腔镜胆囊手术喉罩(laryngeal mask airway,LMA)全身麻醉3种不同方法置入效果。方法将择期腹腔镜胆囊手术使用喉罩全身麻醉患者90例,采用数字表法随机分为A、B、C 3组,每组30例,分别采用常规法(A组)、逆转法(B组)、双手托下颌法(C组)。记录3组一次性就位成功率、置入时间、置入难易程度、术毕拔出喉罩表面是否有血迹、术后24 h咽痛等,同时对3种喉罩置入方法进行比较。结果 3种方法置入喉罩,C组一次性就位成功率为93%,高于A组(60%)和B组(67%),差异有统计学意义(P<0.01);C组喉罩置入时间(40±4.5)s,与A组(61±8.7)s和B组(60±9.3)s相比较,时间明显缩短(P<0.01);C组喉罩置入难易程度评分(1.2±0.37),明显低于A组(1.8±0.70)和B组(1.7±0.66),差异有统计学意义(P<0.05);C组术毕拔出喉罩表面血迹发生率(3%),低于A组(27%)和B组(20%)且术后咽喉痛发生率C组为6%,低于A组(23%)和B组(16%),差异均有统计学意义(P<0.01)。结论双手托下颌法置喉罩更加简便、有效,避免反复置入过程中引起意外损伤,减少术后并发症,在临床麻醉中值得推广。

Objective To compare three different methods of inserting laryngeal mask airways during laparoscopic cholecystec- tomy. Methods Ninety patients scheduled for selective laparoscopie cholecystectomy were assigned to three groups using random num- ber table method ： the standard technique group （ Group A）, rotational technique group （ Group B） and jaw-thrust group （ Group C ）. Each group had 30 patients. The duration of insertion, one-time success rate, ease of placement, post-operative staining of the extractive mask with blood and sore throat 24 hours after operation were recorded and compared between the three different insertion methods. Results In Group C, the one-time success rate was 93% , significantly higher than that of Group A （60%） and Group B （67%） , and the difference was of statistical significance（P 〈 0.01 ）. Insertion took much less time in Group C than in Group A（61± 8.7） sec and Group B （60 ± 9.3 ） sec （ P 〈 0.01 ）. In Group C （ 1.2 ± 0.37 ） , the difficulty score of LMA placement was significantly lower than that in Group A （ 1.8± 0.70 ） and B （ 1.7 ±0.66 ） （ P 〈 0. 05 ）. In Group C （ 3 % ）, the surface of LMA stained with blood was smaller than that in Group A （27%） and B （20%） （P 〈0.01 ）. Incidence of sore throat in Group C（6% ） was decreased obviously compared with A Group A（23% ） and Group B（ 16% ） （P 〈 0.01 ）. Conclusions The jaw-thrust approach is user-friendly and effective,which can prevent accidental injury and reduce postoperative complications. It should be made more popular in clinical anesthesia.