双管型喉罩通气在腹腔镜胆道手术中对血流动力学和通气的影响

目的:观察腹腔镜胆道手术中运用双管型喉罩通气对血流动力学和通气功能的影响。方法:择期行腹腔镜胆囊切除术或腹腔镜胆总管探查术患者48例,年龄25-62岁,ASAⅠ-Ⅱ级,随机分为气管导管组(T组)和喉罩组(L组),每组24例。记录患者入室安静5 min时(T0),插管前即刻(T1)、插管后即刻(T2)、插管后3 min(T3)、拔管时(T4)和拔管后3 min(T5)的平均动脉压(MAP)和心率(HR),并于上述时间点采静脉血检测肾上腺素(E)、去甲肾上腺素(NE)水平;记录间歇通气10 min时(T6)、气腹10 min时(T7)和气腹20 min时(T8)的气道峰压(Ppeak)、潮气量(VT)和呼气末二氧化碳分压(PETCO2)。结果:两组的插管时、间歇通气10 min时和气腹10 min时Ppeak、VT、PETCO2差异无统计学意义(P>0.05)。L组插管后即刻、插管后3 min、拔管时和拔管后3 min的MAP和HR较T组降低(P<0.05)。T组在插管后3 min、拔管时和拔管后3 min的肾上腺素、去甲肾上腺素水平高于L组,且T组在拔管后3 min的肾上腺素、去甲肾上腺素水平高于T0时的基础值(P<0.05)。而L组的肾上腺素、去甲肾上腺素水平在拔管后3 min与T0时的基础值无差别(P>0.05)。结论:双腔型喉罩操作简便,对心血管系统刺激性小,通气可靠。

Effects of Using Proseal Laryngeal Mask Airway Ventilation on Respiration and Hemodynamics During Laparoscopic Biliary Tract Surgery

Objective: To investigate the effects of using Proseal laryngeal mask airway(PLMA) for mechanical ventilation on hemodynamics and ventilation in patients undergoing laparoscopic biliary tract operation.Methods: Forty-eight ASAⅠ-Ⅱ patients aged 25-62 years undergoing aparoscopic surgery were enrolled in the study.The patients were randomized to receive either PLMA(n=24) or endotracheal intubator(n=24).Anesthesia was induced with midazol 0.1 mg/kg,propofol 1 mg/kg,fentanyl 0.4 μg/kg and norcurium 0.12 mg/kg.PLMA insertion were performed by the same highly experienced anesthesiologist.HR and MAP were measured at 5 min after entering the surgery(T_(0)),before inserting PLMA or intubator(T_(1)),immediately after inserting(T_(2)),3 min after inserting PLMA or intubator(T_(3)),immediately after extubating PLMA or intubator(T_(4))and 3 min after extubating PLMA or intubator(T_(5)).Blood specimens were taken at T_(0)-T_(5) for determine of plasma concentration of epinephrine(E) and norepinephrine(NE).Peak inspiratory airway pressure(P_(peak)),minute volume(MV),tidal volume(V_(T)),S_PO_(2),and P_(ET C02)were recorded at 10 min of intermittent positive pressure ventilation(IPPV)(T_(6)),10 min(T_(7)) and 20 min(T_(8)) of peritoneal insufflation.Results: There was no significant difference in P_(peak),MV,V_(T),S_(P)O_(2) and P_(ETC02)at 10 min of IPPV,10 min and 20 min of peritoneal insuffiation between the two groups(P>0.05).The changes in MAP and HR in L group at T_(2),T_(3),T_(4) and T_(5)were less than in the T group(P<0.05).The concentration of E and NE in L group at T_(3),T_(4) and T_(5)were higher than in the T group and the concentration of E and NE in L group at T_(5)were still higher than at T_(0)(P<0.05).Conclusion: PLMA is superior to endotracheal intubation in reducing insertion response and removal response and is efficacious for mechanical ventilation.