腹腔镜结直肠手术中气管导管套囊压力控制对术中血流动力学及术后咽喉痛的影响

Effect of tracheal tube cuff pressure control on intraoperative hemodynamics and postoperative sore throat during laparoscopic colorectal surgery

目的:探讨腹腔镜结直肠手术中气管导管套囊压力控制对术中血流动力学及术后咽喉痛的影响。方法:选择行腹腔镜结直肠癌根治手术的患者94例。采用随机数字表将患者随机分为H组(导管套囊压力控制组,n=48)和L组(指感法组,n=46)。H组患者套囊压力控制在25~30 cmH2O,L组患者仅监测套囊压力。所有患者监测并记录麻醉诱导前(T0)、气管插管后(T1)、建立气腹前(T2)、建立气腹后(T3)、头低足高位后(T4)、气管拔管前(T5)、气管拔管后(T6)时间点的心率(heart rate,HR)、平均动脉压(mean arterial pressure,MAP),以及T1~T5时间点的套囊压力和气道压力。同时调查患者术后2 h、12 h及24 h的咽痛、声嘶情况。结果:L组的HR、MAP、套囊压力在T1~T5均明显高于H组(P<0.05)。两组患者T3时的气道压力均明显上升(P<0.05),T4时均进一步升高(P<0.05),但两组间差异无统计学意义。H组术后2 h、12 h咽痛发生率低于L组(P<0.05)。两组患者术后声嘶发生率及严重程度差异无统计学意义(P>0.05)。结论:腹腔镜手术中,控制气管导管套囊压力可以降低术后咽痛的发生率,并保持术中血流动力学的相对稳定。

Objective:To investigate the effects of tracheal tube cuff pressure control on intraoperative hemodynamics and postoperative sore throat during laparoscopic colorectal surgery.Methods:Ninety-four patients who underwent laparoscopic radical surgery for colorectal cancer were selected.Patients were randomly divided into Group H(tracheal tube cuff pressure control group,n=48)and Group L(finger sensation method group,n=46).The pressure of the tracheal tube cuff in Group H was controlled at 25-30 cmH2O,while patients in Group L were only be monitored for cuff pressure.Heart rate(HR),mean arterial pressure(MAP),cuff pressure,and airway pressure were continuously monitored and recorded at seven time points including pre-induction of anesthesia(T0),after intubation(T1),before establishment of pneumoperitoneum(T2),after establishment of pneumoperitoneum(T3),after Trendelenburg position(T4),before tracheal extubation(T5),and after tracheal extubation(T6).Additionally,the incidence and severity of sore throat and hoarseness were investigated in patients at 2 h,12 h and 24 h after surgery.Results:The HR,MAP,and cuff pressure in Group L were significantly higher than that in Group H at time points T1-T5(P<0.05).The airway pressure in both groups significantly increased at T3(P<0.05)and further increased at T4(P<0.05),but without significant difference between the two groups.The incidence of postoperative sore throat at 2 h and 12 h was lower in group H than that in group L(P<0.05).There was no statistical difference in the incidence and severity of postoperative hoarseness between the two groups(P>0.05).Conclusion:In patients undergoing laparoscopic colorectal surgery,tracheal tube cuff pressure control can reduce the incidence of postoperative sore throat and maintain the relative stability of intraoperative hemodynamics.