i-gel喉罩和气管插管在腹腔镜下卵巢良性肿瘤切除术麻醉中的应用

Application of i-gel laryngeal mask and endotracheal intubation to anesthesia in laparoscopic resection for benign ovarian tumors

目的观察腹腔镜下卵巢良性肿瘤切除术麻醉中i-gel喉罩和气管插管的效果。方法将2016年8月至2018年6月妇科腹腔镜手术的患者60例,按随机表法分为i-gel喉罩组和气管插管组,各30例。比较两组麻醉诱导前(T0)、喉罩或气管导管置入后1min(T1)、5min(T2)、喉罩或气管导管撤除前(T3)、撤除后1min(T4)的血流动力学指标(收缩压、舒张压、心率);观察气腹前、气腹后15min的气道指标[平均气道压(Pmean)、气道峰压(Ppeak)],以及并发症发生情况。结果与T0时相比,气管插管组T1、T3、T4时收缩压、舒张压、心率明显升高(P<0.05)。气管插管组T1~T4时收缩压、舒张压、心率均显著高于i-gel喉罩组(P<0.01)。气腹后15min,两组Pmean、Ppeak均较气腹前显著升高(P<0.01)。i-gel喉罩并发症总发生率低于气管插管组,差异有统计学意义(10.00%vs36.67%,χ^2=5.963,P=0.015)。结论相比气管插管,i-gel喉罩通气应用于腹腔镜下卵巢良性肿瘤切除术麻醉对患者血流动力学影响较小,通气效果好,并发症少,安全性更高。

Objiective To observe the effects of i-gel laryngeal mask and endotracheal intubation on anesthesia in laparoscopic resection of benign ovarian tumors.Methods Sixty patients undergoing gynecological laparoscopic surgery from August 2016 to June 2018 were randomly divided into i-gel laryngeal mask group and tracheal intubation group (n = 30,each).The hemodynamic parameters [systolic blood pressure (SBP),diastolic blood pressure (DBP),heart rate (HR)]were compared before induction of anesthesia (T0),1 min after laryngeal mask or tracheal tube insertion (T1), 5 min after laryngeal mask or tracheal tube insertion (T2),before removal of laryngeal mask or tracheal tube (T3) and 1 min after removal of laryngeal mask or tracheal tube (T4) between two groups.The airway parameters,including mean airway pressure (Pmean),peak airway pressure (Ppeak) before and 15 min after pneumoperitoneum and complications were observed and compared between two groups.Results In intubation group,SPB,DBP and HR at T1,T3 and T4 increased significantly compared with T0 (P < 0.05) and were significantly higher than those in i-gel laryngeal mask group at T1,T2,T3 and T4(P < 0.01).After 15 min of pneumoperitoneum,Pmean and Ppeak increased significantly compared with before pneumoperitoneum in two groups(P < 0.01).The total incidence of complications in i-gel laryngeal mask group was statistically lower than that in intubation group (10.00% vs 36.67%,χ^2 = 5.963,P = 0.015).Conclusion In anesthesia for laparoscopic resection of benign ovarian tumors,i-gel laryngeal mask has less influence on hemodynamics, better ventilation,less complications and more safety compared with endotracheal intubation.