喉罩在腹腔镜胆囊切除术全身麻醉中的应用

Clinical Application of Laryngeal Mask Airway under General Anesthesia during Laparoscopic Cholecystectomy

目的 :探讨在腹腔镜胆囊切除术全麻中喉罩替代气管导管的安全性。方法 :腹腔镜胆囊切除术 6 0例随机分为气管插管组 (30例 )和喉罩组 (30例 )。麻醉前、气管插管或喉罩置入后 5min、气腹后 5min、拔出气管导管或喉罩后 5min记录BP、HR、SpO2 、PETCO2 、气道压力 (Paw)。手术医师在腹腔镜放入腹腔后及手术结束拔出腹腔镜前评估胃膨胀度 (0～3)。结果 :两组SpO2 均维持 98%以上 ,PETCO2 4 7～6 0kPa ,气管插管组与喉罩组胃膨胀发生率和程度相似。两组在人工气腹后Paw均明显增加 (P <0 0 5 )。气管插管组血液动力学指标明显增加 ,喉罩组无显著变化。结论 :喉罩全麻正压通气可安全有效地用于腹腔镜胆囊切除术患者。

Objective: To examine the laryngeal mask airway (LMA) as an alternative to the endotracheal intubation(ETT)under general anesthesia during laparoscopic cholecystectomy. Methods:Sixty patients with laparoscopic cholecystectomy were randomly assigned to LMA group and ETT group. BP, HR, SpO 2, P ET CO 2 and Paw were recorded before induction of anesthesia, 5 minutes after intubation or insertion of LMA, 5 minutes after pneumoperitoneum or after extubation. The surgeon scored gastric distension 0～3 at insertion of the laparoscope and immediately before removal at the end of surgical procedure. Results: In all patients SpO 2 was maintained above 98%, P ET CO 2 was kept between 35～45 mmHg. The incidence and degree of change in gastric distension were similar in LMA and ETT groups. Paw as significantly increased after pneumoperitoneum in both LMA and ETT groups (P<0 05).Hemodynamic indexes were stable in LMA group, but were significantly increased in ETT group during whole operation procedure after intubation. Conclusion: LMA with general anesthesia can be safely used during laparoscopic cholecystectomy.