Supreme喉罩用于妇科腹腔镜手术患者气道管理的效果

目的 评价Supreme喉罩用于妇科腹腔镜手术患者气道管理的效果.方法 择期行妇科腹腔镜手术的患者80例,ASA分级Ⅰ或Ⅱ级,年龄40～64岁,体重50～70 kg,身高158～170 cm,Mallampatis分级Ⅰ或Ⅱ级,随机分为2组(n=40):Supreme喉罩组(S组)和ProSeal喉罩组(P组).麻醉诱导后置入喉罩,行机械通气,并经引流管置入胃管.记录手术时间、气腹时间、清醒时间、喉罩置入时间、喉罩及胃管置入情况;记录喉罩囊内压为60 cm H2O时的充气量和气道密封压,并采用纤维支气管镜进行通气罩咽部解剖结构显露分级;术中监测BP、HR、ECG、SpO2、PETCO2,记录术后咽喉部不良反应的发生情况.结果 两组手术时间、气腹时间、清醒时间比较差异无统计意义(P＞0.05).两组术中BP、HR、SpO2、PETCO2、气道峰压均在正常范围,组间比较差异无统计学意义(P＞0.05).与P组比较,S组喉罩一次置入成功率、胃管一次置入成功率升高,喉罩置入时间缩短,通气罩咽部解剖结构显露分级升高,术后喉罩带血的发生率降低(P＜0.05);两组喉罩置入成功率均为100%,喉罩置入成功率、气道密封压、喉罩充气量比较差异均无统计学意义(P＞0.05).结论 Supreme喉罩通气效果好,气道密封性可靠,易于置入,可安全有效地用于妇科腹腔镜手术患者的气道管理.

Efficacy of laryngeal mask airway Supreme in patients undergoing gynecological laparoscopic surgery

Objective To assess the efficacy of laryngeal mask airway Supreme (LMA Supreme) used in patients undergoing gynecological laparoscopic surgery. Methods Eighty ASA Ⅰ or Ⅱ patients, aged 40-64 yr,weighing 50-70 kg, undergoing elective gynecological laparoscopic surgery, were randomized into 2 groups ( n = 40 each): LMA Supreme group (group S) and LMA ProSeal group (group P). Mallampati test was performed before operation in both groups. The patients were classified as Ⅰ or Ⅱ . LMA Supreme and LMA ProSeal were inserted in group S and P respectively after induction of anesthesia with midazolam 0.05 mg/kg, propofol 2 mg/kg, fentanyl 3 μg/kg and vecuronium 0.1 mg/kg. A gastric tube was inserted through the drain tube of the LMA. The number of attempt, success rate, LMA placement time, success rate of gastric tube placement, cuff volume, peak airway pressure, and airway seal pressure, BP, HR, ECG, SpO2, PET CO2 and complications were recorded. The duration of surgery and pneumoperitoneum, and emergence time were also recorded. The fiberoptic bronchoscope scores were assessed after successful LMA placement. Results There were no significant differences in the duration of operation and pneumoperitoneum, emergence time between the two groups (P ＞ 0.05). The BP, HR,SpO2, PET CO2 and peak pressure were within the normal range during operation in both groups. The first attempt success rates of LMA placement and gastric tube placement were significantly higher, the LMA placement time was significantly shorter, and the fiberoptic bronchoscopic scores were significantly higher in group S than in group P ( P ＜ 0.05). Conclusion LMA Supreme is helpful for ventilation during operation with less complications and can be used effectively for gynecological laparoscopic surgery.