Blockbuster喉罩在侧卧位腹腔镜手术中的应用

Application of Blockbuster laryngeal mask in lateral laparoscopic operation

目的探讨Blockbuster喉罩应用于侧卧位腹腔镜手术的安全性与可行性。方法采用前瞻性研究方法,纳入2018年1~10月首都医科大学附属北京友谊医院泌尿外科收治的拟行侧卧位腹腔镜手术的患者60例。采用随机数字表法将患者分为两组:Blockbuster喉罩组(B组)和气管插管组(T组),每组各30例。患者入手术室后,先将亚甲蓝胶囊快速水送服。10 min后常规麻醉诱导,待肌松起效两组患者分别置入Blockbuster喉罩或者气管插管进行机械通气。记录数据包括:①两组患者在基础值(T1)、插管即刻(T2)、插管后5 min(T3)、拔管前5 min(T4)、拔管即刻(T5)、拔管后5 min(T6)的心率(HR)、收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP);②记录两组患者拔出喉罩或气管导管后是否存在反流、误吸、呛咳情况以及术后患者是否有咽痛、声嘶、黏膜出血情况;③记录B组患者平卧位和侧卧位的气道密封压、纤维支气管镜(FOB)评分。结果与T1基础值相比,在T3和T4时刻两组患者的HR、SBP、DBP、MAP均明显降低,差异具有统计学意义(P <0. 05)。在T2和T3时刻,B组患者的SBP (116. 90±21. 88 mm Hg,109. 60±15. 04 mmHg),明显低于T组的SBP(130. 40±25. 49 mm Hg,119. 30±20. 36 mm Hg);在T4时刻,B组患者的SBP(109. 03±12. 51mm Hg)、DBP(60. 77±7. 56 mm Hg)、MAP(76. 86±8. 47 mm Hg)均明显低于T组的SBP(117. 50±14. 41 mm Hg)、DBP(65. 63±9. 34 mm Hg)、MAP(82. 92±10. 25 mm Hg);T5时刻,B组患者的SBP(119. 70±18. 81 mm Hg)、MAP(83. 08±11. 87 mm Hg)均明显低于T组的SBP(131. 33±18. 38 mm Hg)、MAP(90. 40±12. 10 mm Hg)。差异均具有统计学意义(P<0. 05)。在T6时刻,B组和T组的血流动力学指标差异无统计学意义(P> 0. 05)。反流发生率分别是:B组2例(6. 7%),T组1例(3. 3%),差异无统计学意义(P> 0. 05)。两组患者均未出现误吸。B组拔管期间呛咳的发生率(2例,6. 7%)明显低于T组(19例,63. 3%),差异有统计学意义(P <0. 05)。B组患者仰卧位的气道密封压(26. 83±2. 07mm Hg)明显高于侧卧位气道密封压(25. 53±2. 05 mm Hg),差异有统计学意义(P <0. 05)。结论 Blockbuster喉罩可安全应用于侧卧位腹腔镜手术,提供与气管插管相似的通气效果,且不增加反流误吸的风险,对患者的气道刺激性小,有利于维持患者血流动力学稳定,并提升患者的术后舒适度。

Objective To explore the safety and feasibility of Blockbuster laryngeal mask in lateral laparoscopic surgery. Methods This prospective study was conducted to enroll 60 patients who need to undergo lateral laparoscopic surgery from January to October 2018 in Beijing Friendship Hospital,Capital Medical University. Patients were randomized to two groups: Blockbuster laryngeal mask group( B group),Tracheal intubation group( T group),by using computer-generated numbers,30 patients individually. After the patients entered the operation room,they were administrated a capsule of Methylene blue with water quickly. Conventional anesthesia induction begins 10 minutes later. After induction,the two groups of patients were inserted Blockbuster laryngeal mask or tracheal tube for mechanical ventilation. The data should be recorded:①The heart rate( HR),systolic blood pressure( SBP),diastolic blood pressure( DBP),mean arterial pressure( MAP) of the two groups were recorded before tracheal intubation( base values T1),the moment of tracheal intubation immediately( T2),5 min after tracheal intubation( T3),the moment of 5 min before extubation( T4),the moment of after extubation immediately( T5),and the moment of 5 min after extubation( T6).② To record if there were regurgitation,aspiration and cough after extubation and whether the patients have sore throat,hoarseness,mucosal bleeding after surgery of the two groups.③ To observe the airway sealing pressure and fiber bronchoscope( FOB) scores of group B at the horizontal and lateral position. Results Compared with T1,HR,SBP,DBP,MAP in group B and group T at T3,T4 moment were decreased significantly( P <0. 05). At T2 and T3 moment,SBP of group B( 116. 90 ± 21. 88 mm Hg,109. 60 ± 15. 04 mm Hg) were significantly lower than that of group T( 130. 40 ± 25. 49 mm Hg,119. 30 ± 20. 36 mm Hg). At T4 moment,SBP( 109. 03 ± 12. 51 mmHg),DBP( 60. 77 ± 7. 56 mm Hg) and MAP( 76. 86 ± 8. 47 mm Hg) in group B were significantly lower than that of group T,SBP( 117. 50 ± 14. 41 mm Hg),DBP( 65. 63 ± 9. 34 mm Hg),MAP( 82. 92 ± 10. 25 mm Hg). At T5 moment,SBP( 119. 70 ± 18. 81 mm Hg) MAP( 83. 08 ± 11. 87 mm Hg) in group B were significantly lower than SBP( 131. 33 ± 18. 38 mm Hg),MAP( 90. 40 ± 12. 10 mm Hg) in group T.( P < 0. 05). At T6 moment,there was no significant difference in hemodynamics between group B and group T( P > 0. 05). The rates of regurgitation in two groups were 6. 7% in group B and 3. 3%in group T,there was no significant difference( P > 0. 05). There was no aspiration in two groups. the rate of cough after extubation was 6. 7%in group B and 63. 3% in group T,the difference was significant( P < 0. 05). The airway sealing pressure at horizontal position( 26. 83 ± 2. 07)mm Hg was higher than that at lateral position( 25. 53 ± 2. 05) mm Hg in group B,the difference was statistically significant( P < 0. 05). Conclusion Blockbuster laryngeal mask can be safely applied to lateral laparoscopic surgery and provide the same satisfactory ventilation as tracheal intubation,without increasing the risk of regurgitation and aspiration,It is less irritating to the patient’s airway,which is beneficial to maintain hemodynamic stability and improve the comfort of patients.