喉罩联合丙泊酚靶控输注在妇科腹腔镜手术中的应用

目的 观察喉罩联合丙泊酚靶控输注应用于妇科腹腔镜手术的效果及安全性.方法 选择ASAⅠ～Ⅱ级,年龄18～45岁,择期进行妇科腹腔镜手术的患者60例,将其随机分为两组:A组(喉罩联合丙泊酚靶控输注),B组(气管插管联合丙泊酚静脉输注).记录两组患者诱导前、诱导3 min、置入喉罩(气管导管)即刻、置入喉罩(气管导管)后5 min、拔除喉罩(气管导管)即刻、拔除喉罩(气管导管)后5min的平均动脉压( MAP)和心率(HR)变化.记录两组患者的苏醒时间、拔除喉罩(气管导管)时间.记录两组患者拔除喉罩(气管导管)时的呛咳、咽痛、声嘶等不良反应的发生率.结果 A组患者在置入喉罩即刻、置入喉罩后5 min及拔除喉罩即刻、拔除喉罩后5 min的平均动脉压、心率无明显变化,与诱导前相比差异无显著性(P＞0.05)；B组患者在置入气管导管即刻、置入气管导管后5 min及拔除气管导管即刻、拔除气管导管后5 min的平均动脉压和心率显著升高,与诱导前相比差异有显著性(P＜0.05).A组患者的苏醒时间、拔除喉罩(气管导管)的时间明显短于B组,差异有显著性(P＜0.05).A组患者拔除喉罩(气管导管)时的呛咳反应、术后24h咽痛等不良反应的发生率明显低于B组,差异有显著性(P＜ 0.05).结论 喉罩联合丙泊酚靶控输注应用于妇科腹腔镜手术插管刺激小、血流动力学平稳、术毕清醒快、拔管早、术后并发症少,是妇科腹腔镜手术较理想的麻醉选择.

Application of target-controlled infusion of propofol by laryngeal mask airway in gynecologic laparoscopic surgery

Objective To explore the efficacy and safety of target-conteolled infusion （ TCI ） of propofol by laryngeal mask airway （ LMA ） in gynecologic laparoscopic surgery. Methods 60 ASA Ⅰ-Ⅱ patients aged 18 to 45 and scheduled for surgery were randomly divided into two group. Group A received anesthesia with TCI of propofol by LMA and group B received general anesthesia with tracheal intubation combined with intravenous propofol. Changes in MAP and HR were monitored at pre-induction, 3 min after induction, the moment of intubation or wearing the mask, 5min after intubation or wearing the mask, the moment of removal of the tube or mask, and 5 min after removal of the tube or mask in the two groups. The incidence rates of irritating cough, pharyngodynia, and hoarse voice were noted at the moment of the removal of the tube or mask. Results MAP and HR did not change markedly at the moment of wearing the mask, 5 min after wearing the mask, the moment of removal of the mask, 5 min after removal of the mask in group A, as compared with the baselines （ P〉 0.05 ）. MAP and HR in group B increased significantly at the same time points as those measured in group A, with a statistical difference （ P〈 0.05 ）. Time to consciousness restoration and time to extubation were significantly shorter in group A than in group B （ P〈 0.05 ）. The incidence rate of adverse reactions including irritating cough and pharyngodynia was markedly lower in group A than in group B （ P 〈 0.05 ）. Conclusions TCI of propofol by LMA in gynecologic laparoscopic surgery reduces irritation to intubation, stablizes hemodynamic, and has shorter time to consciousness restoration, earlier extubation and fewer postoperative complications. It is an ideal anesthetic method for gynecologic laparoscopic surgery.