诱导期压力控制面罩通气联合体外压迫在腹腔镜胆囊切除术中的应用价值

Application value of pressure control mask ventilation combined with external compression in laparoscopic cholecystectomy during induction period

目的:探讨全麻诱导期使用压力控制面罩通气联合体外压迫在腹腔镜胆囊切除术中预防胃胀气的应用价值。方法:选择择期行腹腔镜下胆囊切除术病人60例,随机分成观察组和对照组,每组30例。麻醉诱导推注肌松药即刻,观察组给予15 cm H_(2)O压力控制面罩通气并体外压迫胃部,对照组采用单纯15 cmH_(2)O压力控制面罩通气。于麻醉诱导前(T_(0))和扣紧面罩控制通气1 min(T_(1))、2 min(T_(2))、置入气管导管后即刻(T_(3))时记录病人血氧饱和度(SpO_(2));T_(0)和T_(3)时使用超声测量病人胃窦前后轴径及左右轴径并计算胃窦部横截面积(CSA);记录手术开始时腔镜下胃形态分级;术后24 h内恶心呕吐情况。结果:2组病人的年龄、体质量指数、手术时间、麻醉时间差异均无统计学意义(P>0.05)。2组病人T_(0)时胃窦部CSA差异无统计学意义(P>0.05);2组病人CSA T_(3)时与T_(0)时差值间差异有统计学意义(P<0.01),对照组CSA差值高于观察组。术后24 h 2组恶心呕吐发生率比较差异有统计学意义(P<0.05)。结论:全麻诱导期使用压力控制面罩通气联合体外压迫胃部能够改善腹腔镜胆囊切除术病人胃胀气,值得在临床中推广应用。

Objective:To investigate the application value of pressure control mask ventilation combined with external compression in preventing gastric flatulence in laparoscopic cholecystectomy during induction of general anesthesia.Methods:Sixty patients scheduled by laparoscopic cholecystectomy were randomly divided into the observation group and control group(30 cases in each group).Immediately after anesthesia induction and injection of muscle relaxants,the observation group was treated with 15 cmH_(2)O pressure control mask ventilation combined with external compression of the stomach,and the control group was treated with 15 cmH_(2)O pressure control mask ventilation.The oxygen saturation(SpO_(2))in two groups were recorded before anesthesia induction(T_(0)),at 1 min(T_(1))and 2 min(T_(2))after mask control ventilation and immediately after endotracheal tube insertion(T_(3)).The anterior-posterior and left-right axial diameters of gastric sinus were measured using ultrasound T_(0)and T_(3),and the cross-sectional area(CSA)of the gastric sinus was calculated.The endoscopic classification of gastric morphology was recorded at the beginning of the operation.The nausea and vomiting within 24 h after the operation were followed up.Results:There was no statistical significance in the age,body mass index(BMI),operation time and anesthesia time between two groups(P>0.05).There was no statistical significance in the CSA of the gastric sinus at T_(0)between two groups(P>0.05).The differences of the CSA in two groups were statistically significant between at T_(3)and T_(0)(P<0.01),and the difference value of CSA in the control group was higher than that in observation group.The difference of the incidence rates of nausea and vomiting after 24 h of operation were statistically significant between two groups(P<0.05).Conclusions:In the induction period of general anesthesia,the use of pressure control mask ventilation combined with external compression of the stomach can improve the gastric flatulence of patients treated with laparoscopic cholecystectomy,and it is worthy of clinical application.