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Guardian喉罩用于老年腹腔镜胆囊手术患者的通气效果
Efficacy of Guardian laryngeal mask in elderly patients undergoing laparoscopic cholecystectomy
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DOI:
作者:
蔡玉红, 程志军, 尤新民,季惠, 郭云秀
CAI Yu-ong,CHENG Zhi-jun, , YOU Xin-min, JI Hui, GUO Yun-xiu..
作者单位:
新华医院崇明麻醉科
Xinhua Hospital Chongming Branch
关键词:
美迪斯喉罩; 麻醉;腹腔镜胆囊切除术;老年
Guardian laryngeal mask airway;Anesthesia;laparoscopic
摘要:
【摘要】 目的 评价双管美迪斯喉罩(GLAM)用于老年患者腹腔镜胆囊手术的通气效果。 方法 随机选择全麻下行腹腔镜胆囊切除术的老年患者80例,ASA I或II级,性别不限,年龄65~83岁,体重49~76kg, 随机分为美迪斯喉罩组(G组) 和气管插管组(T组)两组(n=40)。静脉注射咪达唑仑0.04mg/kg,丙泊酚1.0mg/kg,舒芬太尼0.3 μg/kg,维库溴铵0.1mg/kg麻醉诱导后G组置入GLAM,T组在喉镜直视下插入气管导管。记录两组患者一般情况,置入喉罩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、Ppeak的数值。记录喉罩头中位、屈曲位、过伸位和侧位时的气道密封效果。应用纤支镜插入喉罩通气管检查对位情况。记录经引流管插入胃管成功次数.拔除喉罩或气管导管后的低氧血症、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,G组置入时间、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G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)。G组气道密封压为26±5cmH2O,不同头位不影响G组患者气道密封效果。第一次胃管放置成功36例占90%。纤支镜证实GLAM位置好。 结论 GLAM气道密封性可靠,可行正压通气且通气效果好,血流动力学稳定,拔除后不良反应发生少且苏醒快,对老年患者呼吸循环功能影响较少,可安全有效地用于老年患者腹腔镜胆囊手术的气道管理。
【Abstract】 Objective To assess the efficacy of Guardian laryngeal mask airway(GLMA)used in elderly patients undergoing laparoscopic cholecystectomy. Methods Eighty ASA I or II patients of both sexes aged 65~83 yr weighing 49-76 kg undergoing laparoscopic cholecystectomy were randomized to 2 groups(n=40 each):GLAM group (group G)and tracheal intubation group(group T).In group G the patients were the inserted GLAM after induction of anesthesia with midazolam 0.04mg/kg, sufentanil 0.3 μg/kg,propofol 1mg/kg and vecuronium0.1mg/kg.A gastric tube was inserted through the drain tube of the GLAM . In group T the patients were intubated under direct laryngoscopy. The success rate, GLAM 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 GLMA 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 GLMA to check its position. 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 G than in group T. The incidence of postoperative hypoxemia, choking and sore throat were significantly lower in group G than in group T(P<0.05). There was no occurrance of regurgitation and aspiration in both groups. HR,MAP were significantly higher in group T in T1 and T2 compare with what in group G(P<0.01) .The airway seal pressure was(26±5)cmH2O in group G .The SpO2, PETCO2, peak airway pressure were within normal range in both groups. Different head and neck position didnˊt change GLMA airway sealing effect. The success rate of gastric tube insertion at first-attempt was 90%, Fiberoptic bronchosopy showed that GLMA was in good position. Conclusion GLMA can provide adequate ventilation during operation with less complications and can be used effectively for laparoscopic cholecystectomy in elderly patients .
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