妇科腹腔镜手术中导管套囊充放气后气腹与体位对门齿-气管隆突距离的影响

Impact of pneumoperitoneum and posture on length of incisors to carina in gynecological laparoscopic surgery

目的观察气管导管套囊充放气后气腹与不同体位对妇科腹腔镜手术患者门齿-气管隆突距离(LIC)的影响。方法90例妇科腹腔镜手术患者依据随机数字表法分成观察组和对照组,每组45例。气管插管全麻后依据手术需要(改变体位、气腹)按顺序测量诱导插管后水平位(T_0)、诱导插管后头低足高位30°(T_1)、水平截石位(T_2)、气腹-水平截石位(T_3)、气腹-头低30°截石位即刻(T_4)、5min(T_5)、10min(T_6)和气腹解除后头低30°截石位(T_7)的LIC,记录患者术后4h及24h咳嗽及术后咽喉痛发生情况。结果两组患者体位改变前后及气腹后各时点的LIC除了水平截石位与诱导插管后水平位比较无明显变化外(P>0.05),其余均有明显缩短(均P<0.05),且观察组缩短更明显;观察组有2例气管导管已进入右支气管内;观察组患者术后4h及24h咳嗽和咽喉痛发生例数均明显少于对照组(均P<0.05)。结论妇科腹腔镜手术中气腹及头低足高位对LIC均有影响,气腹影响更明显,气腹及体位调整前套囊放气对气管黏膜有一定保护作用。

Objective To investigate the impact of pneumoperitoneum and body position on length of incisors to carina(LIC)in patients undergoing gynecological laparoscopic surgery.Methods Nine patients undergoing gynecologic laparoscopic surgery were divided into the control group and the observation group(deflation of endotracheal tube cuff before pneumoperitoneum and postural adjustment).After general anesthesia with tracheal intubation,the LICs were measured after intubation(T0),after induction and intubation low foot high 30 degrees(T1),the level lithotomy position(T2),pneumoperitoneum-level lithotomy position(T3),pneumoperitoneum-30 degree Trendelenburg lithotomy position immediately(T4),pneumoperitoneum-30 degrees low lithotomy position(T5,5min)-low pneumoperitoneum 30 degrees lithotomy position 10min(T6)and 30 degrees behind the low pneumoperitoneum lifting lithotomy position(T7)were recorded.The occurrence of cough 4h and 24h after operation and postoperative sore throat were also recorded.Results The LICs were shortened(P<0.05)after pneumoperitoneum and postural changes in both groups,except in level lithotomy position and level position after intubation(P>0.05);the changes were more marked in the observation group.In 2 cases of observation group the tracheal catheter entered the bronchus;the occurrence of postoperative cough and sore throat in observation group was significantly less than in the control group(P<0.05).Conclusion The pneumoperitoneum and Trendelenburg position in gynecological laparoscopic surgery have certain impact on the length of incisors to carina,particularly for pneumoperitoneum.The deflation of endotracheal tube cuff before the pneumoperitoneum and adjustment of body position have some protective effect on the mucous membrane of trachea.