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双腔Supreme喉罩在老年患者腹腔镜胆囊手术中的应用
Efficacy of Supreme laryngeal mask in elderly patients undergoing laparoscopic cholecystectomy
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DOI:
作者:
程志军,尤新民,季惠,施美新,季晓燕,张海霞,郭云秀
CHENG Zhijun, YOU Xinmin, JI Hui,
作者单位:
上海交通大学医学院附属新华医院(崇明)麻醉科 上海市崇明新华癌痛转化研究所
1.Department of Anesthesiology, Xinhua Hospital (Chongming), Shanghai Jiaotong University School of Medicine 2.Xinhua translational institute for cancer pain
关键词:
喉罩; 麻醉;腹腔镜胆囊切除术;高龄
Supreme laryngeal mask airway;Anesthesia;laparoscopic cholecystectomy;senile
摘要:
目的 评价双腔Supreme喉罩(SLAM)用于80岁以上高龄患者腹腔镜胆囊手术的全麻通气效果。 方法 择期随机选择全麻下行腹腔镜胆囊切除术的高龄患者50例,ASA I-III级,年龄80-89岁,体重48~74kg, 随机分为: SLAM组(S组) 和气管插管组(T组)两组(n=25)。静脉注射咪达唑仑0.04mg/kg,丙泊酚1.0mg/kg,芬太尼0.1mg,维库溴铵0.1mg/kg麻醉诱导后S组置入SLAM,T组在喉镜直视下插入气管导管。记录两组患者一般情况,置入SLAM或插入气管导管的时间和情况。记录术中两组各时点HR、MAP 、SpO2、PETCO2、气道峰压(Ppeak)的数值。记录SLAM头中位、屈曲位、过伸位和侧位时的气道密封效果。应用纤支镜插入通气管检查SLAM对位情况。记录经引流管插入胃管成功次数.拔除喉罩或气管导管后低氧血症、呛咳、恶心呕吐、声嘶、咽喉痛、返流误吸等不良反应的发生情况。记录麻醉时间、拔管时间和苏醒时间。 结果 与T组比较,S组SLAM置入时间、拔管时间和苏醒时间缩短,拔除喉罩后低氧血症、呛咳、咽喉痛的发生率降低(P<0.05)。两组均无返流误吸发生。T组插入气管导管后1min、5min的HR、MAP明显高于S组(P<0.01)。两组各时点SpO2、PETCO2、 和Ppeak均在正常范围内, 组间比较差异无统计意义(P>0.05)。S组气道密封压为25+4cmH2O,不同头位不影响S组患者气道密封效果。胃管放置成功率100%。纤支镜证实SLAM位置好。 结论 SLAM气道密封性可靠,可行正压通气且通气效果好,心血管功能稳定,拔除后不良反应发生少且苏醒快,对高龄患者呼吸循环功能影响较少,可安全有效地用于高龄患者腹腔镜胆囊手术的气道管理。
Objective To assess the efficacy of supreme laryngeal mask airway(SLAM)used in senile patients undergoing laparoscopic cholecystectomy. Methods Fifty ASA I or III patients of aged 80~89yr weighing 48-74 kg undergoing laparoscopic cholecystectomy were randomized to 2 groups(n=25 each):SLAM group (group S)and tracheal intubation group(group T).In group S was the SLAM inserted after induction of anesthesia with midazolam 0.04mg/kg, fentanyl 0.1mg,propofol 1mg/kg and vecuronium0.1mg/kg.A gastric tube was inserted through the drain tube of the SLAM . In group T the patients were intubated under direct laryngoscopy. The success rate, SLAM placement/intubation time, success rate of gastric tube placement, airway seal pressure, SpO2, PETCO2, peak airway pressure and complications (hypoxemia, nausea and vomiting, choking hoarseness, sore throat and regurgitation of gastric contents)were recorded. The airway sealing effect of SLMA. was examined with respectively in 4 head and neck positions (neutral, flexed, extended and turned to side). Fiberoptic bronchoscope was inserted into the airway tube of SLMA to check its position. were recorded. The duration of surgery, anesthesia time, extubation time, and emergence time, were also recoded. Results There was no significant difference in the success rate between the two groups. The placement and removal time and recovery time were significantly shorter in group S than in group T. The incidence of postoperative hypoxemia, choking and sore throat were significantly lower in group S than in group T(P<0.05). Regurgitation of gastric contents were within normal range in both groups. HR,MAP were significantly higher in group T in T1 and T2 compare with what in group S(P<0.01) .The airway seal pressure was(25±4)cmH2O in group S .The SpO2, PETCO2, peak airway pressure were within normal range in both groups. Different head and neck position didnˊt change SLAM airway sealing effect. The success rate gf gastric tube insertion at first-attempt was 100%, Fiberoptic bronchosopy showed that SLAM was in good position. Conclusion SLAM can provide adequate ventilation during operation with less complications and can be used effectively for laparoscopic cholecystectomy in senile patients .
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