喉罩与气管插管全身麻醉在妇科腹腔镜手术中的应用比较

目的比较喉罩加静脉吸入复合全麻、气管插管加静脉吸入复合全麻两种麻醉方法在妇科腹腔镜手术中应用的安全性、可靠性。方法选择ASAⅠ～Ⅱ级妇科腹腔镜手术60例,随机分为两组,每组30例。Ⅰ组为喉罩加静脉吸入复合全麻,Ⅱ组为气管插管加静脉吸入复合全麻,监测记录插管前后心率(HR)、平均动脉压(MAP)的变化,气腹前、气腹后5min气道峰压(Paw)和呼吸末二氧化碳分压(PETCO2)的变化,记录术中及术后腹胀、咽喉痛等并发症的发生例数。结果Ⅰ组置入喉罩前后HR、MAP无明显变化,而Ⅱ组插管后HR、MAP显著高于插管前(P<0.05)。气腹后Ⅰ、Ⅱ组的Paw和PETCO2均显著高于气腹前(P<0.05),SpO2均无明显变化。Ⅱ组并发症的发生率显著高于Ⅰ组(P<0.05)。结论腹腔镜手术中使用喉罩加静脉吸入复合全麻的方法具有安全性好、血流动力学平稳、并发症少的优点。

Comparison of Laryngeal Mask Airway and Endotracheal Intubation in the Gynaecological Laparoscopy with General Anesthesia

Objective To observe the safety and efficacy of the laryngeal mask airway(LMA) in the gynaecological laparoscopy operation under general anesthesia.Methods 60 patients with ASA Ⅰ～Ⅱ scheduled for gynaecological laparoscopy operation under general anesthesia were randomized into 2 groups.laryngeal mask group(groupⅠ,n=30) and endotracheal intubation group(group Ⅱ,n=30).Mean arterial pressure(MAP) and heart rate(HR) were measured just before intubation and after intubation,partial pressure of carbon dioxide in end expired gas(PETCO2) and peak airway pressure(Paw) were measured just before pneumoperitoneum and 5 min after pneumoperitoneum.The rate of gastric distention and sore throat were assessed.Results After intubation,MAP and HR increased significantly in group Ⅱ(P< 0.05),while group Ⅰ had no significant change.After pneumoperitoneum,PETCO2 and Paw increased significantly in each group(P< 0.05).The incidence of gastric distention and sore throat in group Ⅱ were significant higher than those in group Ⅰ(P< 0.05).Conclusion There was less adverse effects of LMA than endotracheal intubation under general anesthesia in the gynaecological laparoscopy operation.