免充气喉罩在老年腹腔镜手术加速康复外科中的应用

Application of inflatable-free laryngeal mask in the enhanced recovery after surgery of laparoscopic surgery for aged patients

目的:观察免充气型(SLIPA)喉罩在老年腹腔镜手术患者加速康复外科中的应用效果。方法:按随机数表法将120例老年腹腔镜手术患者分为SLIPA组(n=60)与食管引流型(PLMA)喉罩组(n=60)。观察手术情况与置入情况,记录置入前(T1)、置入即刻(T2)、置入后5 min(T3)、拔除即刻(T4)、拔除后10 min(T5)时血流动力学指标(平均动脉压、心率)的监测结果,比较T1~T5时两组患者应激反应指标(皮质醇、肾上腺素、去甲肾上腺素)水平,观察不良反应发生情况。结果:两组围手术期各指标、气道密封压差异无统计学意义(P>0.05)。SLIPA组一次置入成功率高于PLMA组,置入时间短于PLMA组,置入相关不良反应发生率低于PLMA组(P<0.05)。T2~T5时,SLIPA组平均动脉压、心率及血浆皮质醇、肾上腺素、去甲肾上腺素水平均低于PLMA组(P<0.05)。结论:老年腹腔镜手术中SLIPA喉罩置入效果、患者血流动力学及应激状态稳定情况、安全性优于PLMA喉罩,符合加速康复外科理念。

Objective:To observe the application effects of streamlined liner of the pharynx airway(SLIPA)laryngeal mask in the enhanced recovery after surgery for elderly patients undergoing laparoscopic surgery.Methods:One hundred and twenty elderly patients undergoing laparoscopic surgery were divided into SLIPA group(n=60)and proseal laryngeal mask airway(PLMA)group(n=60)according to the random number table method.The operation and placement situation were observed,and the results of hemodynamic parameters[mean arterial pressure(MAP),heart rate(HR)]before laryngeal mask placement(T1),immediately at placement(T2),at 5 min after placement(T3),immediately at removal(T4)and at 10 min after removal(T5)were recorded.The levels of stress response indicators[cortisol(Cor),epinephrine(E),norepinephrine(NE)]were compared between the two groups at T1-T5,and the occurrence of adverse reactions was observed.Results:There were no significant differences in the perioperative indexes or laryngeal mask sealing pressure between the two groups(P>0.05).The success rate of one-time laryngeal mask placement in SLIPA group was higher than that in PLMA group,the laryngeal mask placement time was shorter than that in PLMA group,and the incidence of adverse reactions related to laryngeal mask placement was lower than that in PLMA group(P<0.05).At T2-T5,the levels of MAP,HR and plasma Cor,E and NE in SLIPA group were lower than those in PLMA group(P<0.05).Conclusions:SLIPA laryngeal mask for elderly laparoscopic surgery has better placement effects,hemodynamic stability,stress stability and safety than PLMA laryngeal mask,and it is in line with the concept of the enhanced recovery after surgery.