喉罩在腹腔镜手术麻醉中运用的必要性

Necessity of Application of Laryngeal Mask Airway in Laparoscopic Anesthesia

目的比较喉罩与气管插管在腹腔镜手术麻醉中的应用,分析喉罩在腹腔镜手术麻醉中的运用必要性与临床应用效果.方法选取2013年1月至2016年12月曲靖市第二人民医院麻醉科收治的需行腹腔镜手术麻醉的患者76例为对象,按照随机数字表将其分为气管插管组(n=38)及喉罩组(n=38),气管插管组患者一次性气管导管,喉罩组采用I-GEL喉罩,全程观察、记录并比较2组患者麻醉诱导前(T1)、插管(罩)即刻(T2)、气腹即刻(T3)、气腹后10 min(T4)、停止气腹(T5)、拔管(罩)即刻(T6)6个时点的HR、MAP、PETCO2、苏醒时间以及术后苏醒期躁动、拔管时呛咳、术后咳嗽、咽喉痛和声嘶等不良反应发生率.结果喉罩组各个时点的HR、MAP值明显低于气管插管组,2组患异者PETCO2差无统计学意义(P>0.05);喉罩组的苏醒时间为(5.12±3.82)min明显短于气管插管组的(10.14±4.15)min(P<0.05);I-GEL喉罩组的不良反应发生率为5.26%,气管插管组的不良反应发生率为23.68%(P<0.05).结论在腹腔镜手术麻醉过程中,采用I-GEL喉罩,诱导及苏醒期血流动力学平稳,术后苏醒时间短以及术后苏醒期躁动、拔管时呛咳、术后咳嗽、咽喉痛和声嘶等不良反应发生率明显减少.术中通气状况良好,安全性较高,且患者舒适度、满意度高.具有比较好的应用价值,值得推广.

Objective To analyze the necessity and clinical application of laryngeal mask airway anesthesia in laparoscopic surgery through comparing the efficacy of laryngeal mask airway and endotracheal intubation in laparoscopic surgery.Methods We selected76patients undergoing laparoscopic surgery in the Department of Anesthesiologyin Qujing Second People's HospitalFrom January2013to December.According to the random number table,the patients were divided into tracheal intubation group(n=38)and laryngeal mask group(n=38).Tracheal intubation group was given disposable tracheal catheter,laryngeal mask group was given I-GEL laryngeal mask.Then the patients in the2groups were observed and compared in6points of HR,map,PETCO2,recovery time and postoperative restlessness,extubation cough,cough after surgery,the incidence of adverse reactions and hoarseness and sore throat,such as before induction of anesthesia(T1),immediate intubation(cover)(T2),pneumoperitoneum(T3),at10min after pneumoperitoneum(T4),pneumoperitoneum(T5),stop extubation immediately(cover)(T6).Results The HR and MAP values in laryngeal mask group at each time point was significantly lower than those in tracheal intubation group,there was no significant difference in PETCO2between the2groups of patients(P>0.05).The recovery time of patients in laryngeal mask group was(5.12±3.82)min,significantly shorter than that in the intubation group which was(10.14±4.15)min(P<0.05).The incidence of adverse reaction in I-GEL laryngeal mask group was5.26%,The incidence of adverse reactions in the tracheal intubation group was23.68%(P<0.05).Conclusion During laparoscopic anesthesia with I-GEL laryngeal mask airway,patients have stable hemodynamics in induction and recovery period,short postoperative recovery time,and low incidence of adverse reactions such as postoperative restlessness,extubation cough,postoperative cough,sore throat and hoarseness.The ventilation condition of patients during the operation is good and I-GEL laryngeal mask airway has higher safety,comfort and satisfaction degree,so it has good application value and deserves promoting.