Superme喉罩在腹腔镜保胆取石术中的应用

目的：观察Supreme喉罩（ SLMA）与气管插管对腹腔镜保胆取石术患者血流动力学的影响。方法：收集2013年3月至2013年10月接受腹腔镜保胆取石术的60例患者的临床资料,其中喉罩组（30例）采用第3代喉罩插入法进行气道管理；气管插管组（30例）采用气管插管法进行气道管理。对两组置管操作时间、一次性置管成功率、手术时间、术中和术后并发症情况、术中PETCO2和SPO2、置拔管前后心率和平均动脉压等进行比较。结果：在置入喉罩或气管导管后即刻,两组患者HR、MAP均显著增高（ P〈0.05）,且气管插管组显著高于喉罩组（P〈0.05）；拔管前气管插管组HR、MAP显著高于喉罩组（P〈0.05）。两组各时相点SPO2及气腹前、停气腹前即刻PETCO2均处于正常范围,两组比较,差异无统计学意义（ P〉0.05）。两组均能首次成功置入导管,喉罩组和气管插管组置入时间分别为（18±6） s和（16±3） s,两组比较,差异无统计学意义（ P〉0.05）,喉罩组发生并发症7例,显著少于气管插管组的15例（ P〈0.05）。结论：全麻下应用Supreme喉罩能有效通气,患者心血管应激反应小,术后咽喉部并发症少,可安全用于腹腔镜保胆取石术的气道管理。

Application of Superme laryngeal mask airway in laparoscopic cholecystolithotomy

Objective：To analyze the effect of supreme laryngeal mask airway （ SLMA ） and tracheal intubation on hemodynamics in laparoscopic cholecystolithotomy. Methods：Clinical data of 60 patients who were diagnosed and treated by laparoscopic cholecystolithotomy from March 2013 to October 2013 were collected. And SLMA group （ 30 cases） adopted the third generation of laryngeal mask insertion method for airway management;endotracheal intubation group （ 30 cases） adopted endotracheal intubation for airway management. The one-time insertion success rate, operation time, intraoperative and postoperative complications, intraoperative PETCO2 and SPO2 , heart rate before and after intubation and extubation, and mean arterial pressure, etc. between these two groups were compared. Results：Both HR and MAP in each group were significant higher after the placement of laryngeal mask or endotracheal tube （P〈0.05）, and endotracheal intubation group was significant higher than SLMA group （ P〈0.05）;HR and MAP in endotracheal intubation group were significant higher than SLMA group before extubation （ P〈0.05） . The two groups’ SPO2 at each time phase, PETCO2 at pre-pneumoperitoneum and at the stop of pre-pneumoperitoneum were within the normal range, and there was no statistical significance between the two groups （ P〉0. 05 ） . Both groups could be inserted tubes successfully at the first time. The insertion time of SLMA group and endotracheal intubation group was （18±6）s and （16±3）s respectively, and there was no statistical significance between the two groups （P〉0.05）. There were 7 cases with complication in the SLMA group, which was significantly less than 15 cases of the endotracheal intubation group （P〈0.05）. Conclusion：The application of SLMA under general anesthesia helps ventilation effectively, which can be safely used during laparoscopic cholecystolithotomy for airway management, with small cardiovascular stress reaction and less postoperative throat complicatio