两种喉罩置入方法用于妇科腹腔镜全麻手术的效果对比

Comparison of two laryngeal mask insertion methods for gynecologically laparoscopic general anesthesia

目的:比较常规法喉罩置入与双手托下颌法喉罩置入在妇科腹腔镜全麻手术中的应用效果。方法:收集122例行妇科腹腔镜全麻手术患者资料,按喉罩不同置入方法将其分为常规法组和双手托下颌法组,每组61例。两组患者均给予相同的麻醉方法,均使用欧普乐第三代新型免充气喉罩,并根据患者体重选择喉罩型号。常规法组采用常规法置入喉罩,双手托下颌法组采用双手托下颌法置入喉罩,比较两组患者首次置入成功率、置入时间、置入难易程度评分、肺通气质量、并发症发生情况及麻醉诱导开始前(T0)、放置喉罩时(T1)、气腹后30 min(T2)及拔管后(T3)心率(HR)以及平均动脉压(MAP)水平的变化。结果:双手托下颌法组首次置入成功率为95.08%,显著高于常规法组的80.33%,其差异有统计学意义(x^2=6.157,P<0.05);双手托下颌法组置入时间及置入难易程度评分均显著低于常规法组,差异有统计学意义(t=9.281,t=12.029;P<0.05);双手托下颌法组肺通气质量良好率为100.00%,显著高于常规法组的85.25%,差异有统计学意义(x^2=7.677,P<0.05);双手托下颌法组T1、T2及T3时HR和MAP水平均明显低于常规法组,差异有统计学意义[HR(t=4.188,t=3.607,t=4.159;P<0.05);MAP(t=10.962,t=3.895,t=8.719;P<0.05)];双手托下颌法组咽痛、喉罩染血迹和躁动发生率均显著低于常规法组,差异有统计学意义(x^2=4.319,x^2=7.677,x^2=6.971;P<0.05)。结论:双手托下颌法置入喉罩具有首次置入成功率高、操作简便、并发症少以及通气效果佳等优点,具有一定的临床应用价值。

Objective:To compare the effects of routine laryngeal mask insertion and laryngeal mask insertion with two-handed mandible method in gynecologically laparoscopic general anesthesia.Methods:The data of 122 patients undergoing gynecologically laparoscopic general anesthesia were collected and all of patients were divided into two groups according to different insertion methods of laryngeal mask:routine method group(61 cases)and two-handed mandible method group(61 cases).Both groups were implemented the same anesthesia method,and all of these patients used the third generation of OPL non-inflation laryngeal mask,and different types of laryngeal mask were chosen according to the weight of patients.The laryngeal masks were inserted in patients of routine group as routine method and they were inserted in patients of other group by using two-handed mandible method.The success rate of first insertion,insertion time,insertion difficulty score,pulmonary ventilation quality,complication,and the changes of heart rate(HR)and mean artery pressure(MAP)before anesthesia induction(T0),during laryngeal mask insertion(T1),30 minutes after pneumoperitoneum(T2)and after extubation(T3)of the two groups were compared.Results:The successful rate of first insertion of the two handed mandible group was 95.08%,which was significantly higher than that of the routine group(80.33%)(x^2=6.157,P<0.05).The insertion time and insertion difficulty score of the two handed mandible group were significantly lower than those of routine group(t=9.281,t=12.029,P<0.05),respectively.The fine rate of lung ventilation quality of the two handed mandible group was 100%,which was significantly higher than that of the routine group(85.25%)(x^2=7.677,P<0.05).At T1,T2 and T3,the levels of HR and MAP of two handed mandible group were significantly lower than those of the routine group[HR(t=4.188,t=3.607,t=4.159,P<0.05.MAP(t=10.962,t=3.895,t=8.719,P<0.05)],respectively.The incidences of pharynx pain,laryngeal mask with blood and agitation of the two handed mandible group were significantly lower than those of the routine group(x^2=4.319,x^2=7.677,x^2=6.971,P<0.05).Conclusion:The two-handed mandible of insertion laryngeal mask has series of advantages include of high success rate of first insertion,simple operation,fewer complication and good ventilation effect,so it has a certain clinical value in application.