Proseal喉罩在妇科腹腔镜手术麻醉中的应用

目的观察正压通气下Proseal喉罩用于妇科腹腔镜手术的安全性、可行性。方法妇科腹腔镜择期手术病人50例,ASAⅠ~Ⅱ级,随机分为喉罩组(L组,25例)和气管插管组(T组,25例),麻醉后记录心率(HR)、平均动脉压(MAP)、气道峰压(Pmax)、气道平均压(Pmean)、脉搏血氧饱和度(SpO2)、呼气末二氧化碳分压(PETCO2)、动脉血二氧化碳分压(PaCO2)的数值及插管(罩)期、拔管(罩)期、术后24h相关并发症。结果(1)HR、MAP变化:插管(罩)期和拔管(罩)期T组明显升高(P<0.05),L组无明显变化(P>0.05)。(2)两组PETCO2、PaCO2、Pmax、Pmean随麻醉、气腹的影响变化是一致的,组间比较各时间点差异无显著性(P>0.05),两组的SpO2一直保持稳定水平。(3)两组并发症比较:插管(罩)期L组有3例体动,1例呛咳,T组无体动及呛咳,差异无显著性(P>0.05);拔管(罩)期T组体动、呛咳发生率明显高于L组(P<0.05);术后24h咽痛、声嘶发生率T组明显高于L组(P<0.05)。(4)手术医师对手术条件的评价100%满意。结论本研究显示妇科腹腔镜手术中Proseal喉罩可以达到与气管插管一样满意的通气效果,且安全可靠。

Proseal laryngeal mask airway used in gynaecological laparoscopy

Objective To observe the safey and efficacy of LAM-Proseal used in gynecologic laparoscopy under positive pressure ventilation. Methods Fifty patients undergoing elective gynaecological laparoscopy were randomly allocated to either laryngeal mask airway group(L, n=25) or tracheal tube group(T, n=25). After anesthesia induction and tracheal or laryngeal mask intubation,HR, interval noninvasive MBP, SpO_2,P_(ET)CO_2,P_(max),P_(mean ), PaCO_2 laryngeal mask introcuff pressure(P_(cuff)) were monitored.Results HR and MBP in group T were significantly increased after insertion and before extubation,which was not in group L. SpO_2 had no chang during operation in tow groups. P_(ET)CO_2, PaCO_2, P_(max), P_(mean)were similar at all the time points between the two groups. Group T had highter incidence of body movment and coughing before extubation (P<0.05), and highter incidence of sore throat postoperatively. There was no significant difference in the quality of surgical condition between the two groups. Conclusion LMA-Proseal can provide the same safe and effective ventilation as tracheal intubation in gynaecological laparoscopy.