气管插管全麻与喉罩全麻用于腹腔镜胆囊切除患者麻醉效果的观察

The Effect of General Anesthesia with Tracheal Intubation Versus General Anesthesia with Laryngeal Mask in Patients Undergoing Laparoscopic Cholecystectomy

目的:研究腹腔镜胆囊切除患者使用喉罩全麻和气管插管全麻后的效果及对血流动学的影响分析。方法:选取在我院择期行腹腔镜胆囊切除术的患者60例,随机分为喉罩全麻组和气管插管全麻组,各30例。观察两组患者麻醉诱导前(T0)、诱导后喉罩与气管插管置入前(T1)、喉罩与气管插管置入时(T2)、腹腔镜置入时(T3)、手术进行30min时(T4)、术前改良镇静清醒评分(OAA/S)≥4分时(T5)等时间点的心率(HR)、收缩压(SBP)、舒张压(DBP)、血氧饱和度(SpO2)、脑电双频谱指数(BIS)、阿曲库铵和异丙酚的使用剂量,同时观察两组患者在拔除喉罩和气管插管时患者的反应和麻醉后的清醒时间。结果:喉罩组麻醉满意度为90.00%,明显高于气管插管组73.33%(χ^(2)=9.815,P<0.05);喉罩组异丙酚和阿曲库铵的使用剂量明显少于气管插管组(t=2.177、4.162,P<0.05);喉罩组患者苏醒时间明显短于气管插管组,且体动呛咳反应发生率明显低于气管插管组(t/χ^(2)=3.175、6.812,P<0.05);喉罩组T2、T4时间点中SBP、DBP和HR水平明显低于气管插管组(P<0.05),但各时间点两组患者的BIS值经比较差异无统计学意义(P>0.05)。结论:腹腔镜胆囊切除术中采用喉罩全麻可有效减少麻醉药物的使用剂量,同时患者血流动学较气管插管全麻患者稳定,且患者术后苏醒快等优点值得临床推广应用。

Objective:To study the effect of general anesthesia with laryngeal mask versus general anesthesia with tracheal intubation in patients with laparoscopic cholecystectomy and the influence on hemodynamics.Methods:A total of 60 patients undergoing laparoscopic cholecystectomy in our hospital were selected and randomly divided into a laryngeal mask general anesthesia group and an tracheal intubation general anesthesia group,30 cases in each.The heart rate(HR),systolic blood pressure(SBP),diastolic blood pressure(DBP),blood oxygen saturation(SpO2),electroencephalographic bispectral index(BIS),and the dose of atracurium and isoproterenol were observed at the time points before induction of anesthesia(T0),before laryngeal mask and tracheal intubation placement after induction(T1),at the time of laryngeal mask and tracheal intubation placement(T2),at the time of laparoscopic placement(T3),at 30 min into the operation(T4),and when the preoperative modified sedation and wakefulness score(OAA/S)was≥4(T5)in the two groups.The doses of atracurium and isoproterenol were also observed,as well as the patient's response and post-anesthesia wakefulness time during removal of the mask and tracheal intubation in both groups.Results:The satisfaction rate of anesthesia in the laryngeal mask group was 90.00%,which was significantly higher than that in the tracheal intubation group,which was 73.33%(χ^(2)=9.815,P<0.05).The doses of propofol and atracurium in the laryngeal mask group were significantly lower than those in the tracheal intubation group(t=2.177,4.162,P<0.05);the awakening time of the patients in the laryngeal mask group was significantly shorter than that in the tracheal intubation group,and the incidence of somatic choking reaction was significantly lower than that in the tracheal intubation group(t/χ^(2)=3.175,6.812,P<0.05);the levels of SBP,DBP and HR in the laryngeal mask group at time points T2 and T4 were significantly lower than those in the tracheal intubation group(P<0.05),but there was no significant difference in the BIS values between the two groups at each time point(P>0.05).Conclusion:The use of laryngeal mask general anesthesia in laparoscopic cholecystectomy can effectively reduce the dosage of anesthetic drugs,and the patient's blood flow is more stable than that of tracheal intubation patients under general anesthesia,and the patients wake up quickly after surgery.It is worthy of clinical application.