SLIPA喉罩用于全麻妇科腹腔镜手术气道管理的效果分析

Efficacy of SLIPA Laryngeal Mask in Airway Management for Gynecological Laparoscopic Surgeries under General Anesthesia

目的:观察SLIPA喉罩用于全麻妇科腹腔镜手术中气道管理的安全性和有效性。方法:选80例择期妇科腹腔镜手术患者,美国麻醉师协会(ASA)分级Ⅰ~Ⅱ级,随机分SLIPA喉罩组(S组)、气管插管组(T组)。记录插管时间、首次置管成功率;观察基础值(T_0)、插管后1min(T_1)、插管后3min(T_2)、拔管前即刻(T_3)和拔管后1min(T_4)各时点的平均动脉压(MAP)、心率(HR)和血氧饱和度(SpO_2),比较两组控制呼吸时气腹前后不同时段的气道峰压(Ppeak)、潮气量(Vt)、呼气末二氧化碳分压(PETCO_2)及插管相关并发症。结果:T组患者T_1、T_3、T_4的MAP和HR比T_0和S组各对应时点均明显升高,差异有统计学意义,S组T_2时MAP明显低于T_0时,差异有统计学意义(P<0.05)。两组患者术中通气均满意,Ppeak、VT、PETCO_2组间比较各时点差异无统计学意义(P>0.05)。与气腹前比较,气腹后Ppeak和PETCO_2组内比较均高于气腹前,差异有统计学意义(P<0.05)。S组置管时间明显短于T组(P<0.05)。两组首次置管成功率差异无统计学意义。拔管期及术后24h并发症,S组明显低于T组,差异有统计学意义(P<0.05)。结论:SLIPA喉罩用于全麻妇科腹腔镜手术通气效果满意,患者应激反应小,安全可行。

Objective: To evaluate the safety and efficacy of SLIPA laryngeal mask in airway management for gynecological laparoscopic surgeries under general anesthesia. Methods: Eighty patients who underwent elective gynecologic laparoscopic surgery with ASA status Ⅰ~ Ⅱ were enrolled and randomly divided into SLIPA laryngeal mask group( S group) and endotracheal intubation group( T group). Time for intubation and the success rate at the first attempt were recorded. Measurements of mean arterial pressure( MAP),heart rate( HR)and oxygen saturation( SpO_2) at baseline( T_0),1 min( T_1) after intubation,3 min( T_2) after intubation,immediately before extubation( T_3),and 1 min after extubation( T_4) were collected. Airway peak pressure( Ppeak),tidal volume( Vt),End-tidal CO_2 partial pressure( PETCO_2) were compared between two groups before and after establishing pneumoperitoneum,as well as intubation-related complications. Results: MAP and HR of the T group at points of T_1,T_3 and T_4 were significantly higher than those at T_0 as well as those of the S group( P < 0. 05). MAP of the S group at T_2 was significantly lower than T_0( P < 0. 05). Satisfying controlled ventilation were achieved in both groups and no significant differences in Ppeak,VT and PETCO_2 were observed between the two groups( P > 0. 05). Ppeak and PETCO_2 after were significantly higher than those before establishing pneumoperitoneum( P < 0. 05). Intubation time in the S group was significantly shorter than the T group( P < 0. 05). There was no significant difference in first-attempt success rate between two groups. There was significant difference between the two groups as in complications during extubation and postoperative 24 h( P < 0. 05). Conclusion: SLIPA laryngeal mask is safe and feasible for airway management in gynecological laparoscopic surgeries,with satisfying ventilation but less intubation responses.