Supreme喉罩在68例妇科腹腔镜全麻手术中的应用效果

目的：探讨Supreme喉罩在妇科腹腔镜手术中的安全性、有效性、临床效果及并发症.方法：选择135例2010年10月-2012年1月在本院全麻下行妇科腹腔镜手术ASA为Ⅰ~Ⅱ级的患者,随机分为LMA组（68例,采用Supreme喉罩）和ETT组（67例,采用气管插管）.观察记录两组的手术时间、麻醉时间、拔管/罩时间及患者苏醒的时间;插管/罩5 min（T1）、腹腔注气前5 min（T2）、腹腔注气后30 min（T3）、腹腔放气后5 min（T4）时脉搏血氧饱和度（SpO2）、呼气末二氧化碳分压（PETCO2）和气道峰压（Ppeak）的变化及通气效果;记录患者拔管/罩后呛咳、体动、反流、误吸、恶心、呕吐及术后咽喉痛等不良反应的发生情况.结果：两组手术和麻醉时间比较,差异无统计学意义（P〉0.05）;LMA组插管/罩、拔管/罩和苏醒时间均显著短于ETT组,比较差异有统计学意义（P0.05）;拔管/罩期间,LMA组呛咳、体动及术后咽喉痛的发生明显少于ETT组,比较差异有统计学意义（P〈0.05）;两组患者均无反流、误吸.结论：Supreme喉罩通气用于妇科腹腔镜全麻手术对患者循环功能影响小,操作简单,通气效果好,术后并发症少,可完全替代气管插管全麻安全有效地用于妇科腹腔镜手术.

Application Efficacy of Laryngeal Mask Airway Supreme Used with General Anesthesia in 68 Patients Undergoing Elective Gynecological Laparoscopy Surgery

Objective：To explore the safety,efficacy and side effect of laryngeal mask airway supreme（LMA Supreme）in general anesthesia undergoing gynecological laparoscopy surgery. Method：135 ASA gradeⅠ-Ⅱpatients under general anesthesia for elective gynecological laparoscopy surgery were reviewed from Oct. 2010 to Jan. 2012 in the first affiliated hospital of Xiamen University,68 of which were dealt with LMA Supreme（Group LMA）and 67 with endotracheal tube（Group ETT）. Operation time,anesthesia time,extubation time,and patient recovery time were observed;SpO2, PETCO2,the peak inspiratory airway pressure（Ppeak）and the effectiveness of ventilation were monitored when LMA Supreme or endotracheal tube placement after 5 min（T1）,5 min before intraperitoneal injection gas（T2）,30 min after intraperitoneal injection gas（T3）,intraperitoneal exhaustion gas after 5 min（T4）. Relevant perioperative side effects were recorded. The adverse reactions of anesthesia were recorded included bucking,body movement,countercurrent,aspiration retching,vomiting and postoperative pharyngolaryngeal adverse events in the two groups during extubation. Result：Operation and anesthesia time were not significantly different in the two groups. Intubation,tracheal extubation and recovery times were significantly shorter in group LMA than that in group ETT（P0.05）. The patients bucking,body movement during extubation and postoperative sore throat in group LMA were found significantly lower than those in group ETT（P〈0.05）,and no countercurrent,aspiration and vomiting in the two groups during extubation. Conclusion：LMA Supreme can provide the same safe and effective ventilation as intubation in gynecological laparoscopy,which can insert easy with fewer the adverse effects,making it can be as a substitute for tracheal intubation and safely and effectively used for gynecological laparoscopy.