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喉罩通气在腹腔镜妇科手术中的临床应用效果
The clinical efficacy of laryngeal mask airway on gynecological laparoscopy operation
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DOI:
作者:
杨琦琳
Yang qilin
作者单位:
上海国际和平妇幼保健院麻醉科
Department of Anesthesiology, the International Peace Maternity and Child Health Hospital, Affiliated Hospital of Shanghai Jiao Tong University School of Medicine
关键词:
喉罩通气 气管插管 单管喉罩 双管喉罩 腹腔镜妇科手术
laryngeal mask airway; tracheal intubation; single-tube laryngeal mask; proseal laryngeal mask; gynecological laparoscopy operation
摘要:
目的:比较喉罩通气和气管插管在腹腔镜妇科手术中的临床应用效果。方法:90例ASA I~Ⅱ 级择期行腹腔镜妇科手术患者,随机分为气管插管(T)组,单管喉罩(L1)组,双管喉罩(L2)组,每组30例,手术时间在一小时内。记录各组诱导前(T0),诱导后即刻(T1),置罩(或管)后即刻(T2),置罩(或管)后1分钟(T3),气腹后(T4),气腹后15分钟(T5),术毕(T6),拔除罩(或管)前(T7),拔除罩(或管)后(T8)的SBP,DBP,HR, SPO2和 ,Ppeak。记录各手术患者自主呼吸恢复时间,苏醒时间和拔管时间。记录术毕患者烦躁和咽喉疼痛发生率和程度,以及有无反流误吸发生。结果:T组SBP在T3,T7时高于L1组和L2组(P<0.01);DBP在T7时高于L1组和L2组(P<0.05);HR在T2,T3,T4,T7,T8时均高于L1组和L2组(P<0.05,P<0.01)。与T0比较,T组SBP在T7、T8上升(P<0.01,P<0.05);DBP在T4、T7上升(P<0.01);HR在T7、T8升高(P<0.05,P<0.01)。与T0比较,L1和L2组DBP在 T4上升(P<0.05);HR与T0比较各时点均无差异。T组在T2~T7时Ppeak高于L1和L2组(P<0.05)。苏醒时间和拔除气管导管时间,T组明显长于L1组和L2组(P<0.05,P〈0.01);术毕烦躁和咽喉疼痛程度,T组明显重于L1组和L2组(P<0.01);L1,L2组均无误吸。结论:喉罩通气用于腹腔镜妇科短小手术,与气管插管相比,对患者血流动力学影响小,特别是拔管期更具有明显优势;苏醒时间和拔除喉罩时间短;通气效果好;术毕烦躁和咽喉疼痛程度降低;双管喉罩比单管喉罩能有效地防范返流、误吸的发生。
Object: To compare the clinical efficacy of laryngeal mask airway versus tracheal intubation used in gynecological laparoscopy operation under general anesthesia. Method: 90 patients as ASA I-II grade for elective gynecological laparoscopy were consented and randomly allocated to three groups (n=30): T (tracheal intubation) group, L1(single-tube laryngeal mask airway) group, L2(proseal laryngeal mask airway) group. Patients were intubated with T1, L1 or L2 respectively after general anesthesia induction. Parameters of SBP, DBP, HR, SpO2; time for anesthesia, operation, recovery of spontaneous respiration and awake, ease of mask or tube as well as the incidence of relevant perioperative or postoperative side effects such as backflow, aspiration, sore throat were recorded at different time points of before (T1) or right after(T2) anesthesia induction , right after (T3) or 1 minute (T4) after mask or tube placement, right after creation (T5) of or 15 minutes after (T6) pneumoperitoneum, right after operation (T7), before (T8) or after (T9) removal of mask or tube. Results: SBP in T group increased significantly at T3 and T4 (p< 0.05) and DBP rose at T7 (p < 0.05) compared to L1 and L2 group. HR in T group at T2, T3, T4, T7, T8 was faster than L1 (p < 0.05) and L2 (p < 0.01) group. Contrast to T0, SBP in T group rose at T7 (p<0.05) and T8 (p<0.01), DBP elevated significantly both at T4 and T3 (p<0.01), and HR also was faster at T7 (p<0.05) and T8 (p<0.01). All parameters in L1 and L2 group were within normal range except DBP in L1 group elevated at T4 (p<0.05). In T group, the time both for recovery of consciousness and ease of tube prolonged significantly compared to L1 (p<0.05) and L2 (p<0.01) group. Postoperative agitation and sore throat in T group were more severe than L1 and L2 group with a significance of p < 0.01. No aspiration was observed in both L1 and L2 group except for some backflow in 2 patients in L1 group and 3 patients in L2 group. Conclusions: Laryngeal mask airway is safely or conveniently applicable in gynecological laparoscopy. It impacts little on variations on hemodynamics after general anesthesia with short time for insertion, recovery of consciousness, attenuating perioperative and postoperative side effects such as agitation, sore throat and aspiration. L2 is superior to L1 in preventing more effectively from backflow and aspiration.
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