喉罩与气管插管对腹腔镜下胆囊切除术患者胃胀气及术后恶心呕吐的影响

Influence of laryngeal mask airway and tracheal intubation on flatulence and postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy

目的探讨喉罩与气管插管对腹腔镜下胆囊切除术患者胃胀气及术后恶心呕吐(PONV)的影响。方法选取2016年9月~2017年9月在常州市中医医院行择期腹腔镜下胆囊切除术的90例患者,按照随机数字表法分为气管插管(T)组、喉罩压力控制通气(P)组和喉罩容量控制通气(V)组,每组各30例。使用超声测定喉罩(或气管导管)置入成功后(T0)和手术结束后(T1)的胃窦面积(GAA)变化,并比较三组患者术后恶心呕吐发生率。结果三组患者T0时的GAA比较,差异无统计学意义(P>0.05);V组和P组T1时的GAA大于T0,差异有统计学意义(P<0.05);V组和P组T1时的GAA大于T组,差异有统计学意义(P<0.05);V组和P组T1时PONV的发生率高于T组,差异有统计学意义(P<0.05)。结论与常规气管插管比较,喉罩全身麻醉患者术后胃胀气以及PONV发生率明显增高。

Objective To investigate the influence of laryngeal mask airway and tracheal intubation on flatulence and postoperative nause and vomiting(PONV)in patients undergoing laparoscopic cholecystectomy.Methods A total of 90 patients undergoing elective laparoscopic cholecystectomy at Changzhou Traditional Chinese Medicine Hospital from September 2016 to September 2017 were enrolled.According to the random number table methods,they were divided into the tracheal intubation(T)group,the laryngeal mask pressure control ventilation(P)group and the laryngeal mask volume control ventilation(V)group,30 cases in each group.Ultrasound was used to measure changes in gastric antrum area(GAA)after successful placement of the laryngeal mask or tracheal tube(T0)and after surgery(T1),and the incidence of PONV were compared between the three groups.Results There were no significant differences in GAA between the three groups at T0(P>0.05).The GAA of group V and group P at T1 were larger than those at T0,the differences were statistically significant(P<0.05).The GAA at T1 of group V and group P were larger than those of group T,the differences were statistically significant(P<0.05).The incidence of PONV of group V and group P were higher than that of group T,and the differences were statistically significant(P<0.05).Conclusion Compared with conventional tracheal intubation,the degree of gastric distention and the incidence of PONV after general anesthesia with LMA are significantly increased.