SLIPA喉罩在高龄合并高血压患者腹腔镜胆囊手术中的应用

目的 探讨SLIPA喉罩(Streamlined Liner of the pharynx airway)麻醉在80岁以上合并高血压患者腹腔镜胆囊手术中(LC)应用的安全性和可行性.方法 30例ASAⅡ~Ⅲ级接受LC的高龄合并高血压患者,随机分为气管插管全麻组和SLIPA喉罩组,每组15例.观察2组在气管插管、SLIP...     

喉罩与气管插管对腹腔镜胆囊切除术患者术后躁动影响观察

目的 观察Supreme喉罩预防/减少全麻术后躁动的有效性.方法 选择行腹腔镜胆囊切除手术180例患者,采用抽签的方法将所有患者随机双盲分为喉罩置入组(L组,n=90)和气管内插管组(T组,n=90).全程观察患者在手术间及麻醉后监测治疗室(post-anesthesia care unit,PACU)中躁动的发生率及...     

喉罩与气管插管对腹腔镜胆囊切除术患者术后躁动影响观察

Objective To observe the validity of Supreme laryngeal mask airway (SLMA) to prevent/reduce postoperative agitation after general anesthesia. Methods 180 cases of elective laparoscopic cholecystectomy were randomly assigned to SLMA group (L group, n=90) or endotracheal intubation group (T group, n=90). The incidence and severity of postoperative agitation were recorded both in the operation room and post-anesthesia care unit (PACU)(graded as 0 to 3). Results The incidence of postoperative agitation in L group was 7.78%, and 18.89% in T group (P＜0.01); the severity of postoperative agitation was obviously palliated in L group than in T group (P＜0.01). Conclusion Under general anesthesia, SLMA can effectively prevent/reduce the incidence of postoperative agitation in laparoscopic cholecystectomy patients.     

腹腔镜胆囊切除术中血流动力学变化及监测

腹腔镜胆囊切除术因其独特的优点很快被人们所接受，术中因受麻醉，体位及气腹等因素的影响，血流动力学的变化是很明显的。本文综述了术中血流动力学的变化及其监测。     

全麻腹腔镜胆囊切除术和剖腹胆囊切除术对血流动力学的影响

对全麻下２２例腹腔镜胆囊切除术（ＬＣ）和１０例剖腹胆囊切除术（ＯＣ）的血流动力学作了前瞻性比较观察。两组患者一般状况和麻醉方法相仿。由ＮＣＣＯＭ３型心血管监测仪监测结果表明，ＬＣ组气腹后ＭＡＰ、ＳＶ、ＳＩ、ＥＶＩ和ＣＯ、ＣＩ均较手术开始明显下降（Ｐ＜０．０５和Ｐ＜０．０１）；牵拉胆囊时变化不明显；气腹后有３例需给麻黄碱维持血压平稳，气道峰压和平台压明显增高（Ｐ＜０．０１）。ＯＣ组牵拉胆囊时ＳＶ、ＣＯ和 ＥＶＩ下降明显（Ｐ＜０． ０５），进腹探查和胆囊切除时降低不明显。提示 ＬＣ对循环影响最明显的是ＣＯ２气腹，ＯＣ是牵拉胆囊，且前者比后者对循环影响更明显。     

异丙酚麻醉和腹腔镜胆囊切除术对血流动力学的影响

目的;了解异丙酚麻醉和腹腔镜胆囊切除术（ＬＣ）对血流动力学的影响。方法;在８例非肥胖ＡＳＡⅠ－Ⅱ级患者使用异丙酚２ｍｇ／ｋｇ,静脉诱导前,后５和１０分名目气腹（腹内压０．６７,１．３３和２ｋＰａ）,反向屈氏卧位后５,２０和３５分钟。放气后２,１５和３０分钟,分别测录ＭＡＰ,肺动脉压,肺毛细血管楔压,ＣＶＰ,心输出量（热稀释法）。     

腹腔镜胆囊切除术对血流动力学及通气功能影响的分析

腹腔镜胆囊切除术对血流动力学及通气功能影响的分析计根林，曾祥龙，吴宝林，白晓光腹腔镜下胆囊切除术（ＬＣ）具有损伤轻、痛苦少、恢复快等优点，已在临床广泛开展。然而较长时间腹腔内灌注ＣＯ２对患者的血流动力学及通气功能的影响为人们所关注。为此，作者对１００...     

喉罩在腹腔镜下胆囊切除术的临床应用

目的：喉罩（LMA）作为声门上通气装置．是近二十年来气道维持中最重要的发明。近年来喉罩已广泛应用于全麻中。替代了气管插管。本文探讨喉罩在腹腔镜下胆囊切除术中的应用。方法：选择腹腔镜下胆囊切除病人（ASAⅠ～Ⅱ）100例．并随机分为喉罩组（V组）50例和气管插管组（C组）50例。两组病人术前均肌注阿托晶、鲁米那,入室后开放静脉,麻醉诱导用咪唑安定、芬太尼、维库溴铵、异丙酚．肌松后V组放入喉罩．C组插入气管导管．麻醉维持两组均泵入异丙酚,静注芬太尼和维库溴铵。结果：V组麻醉3min后病人MBP、HR无明显改变,而C组MBP升高、HR增快,CO2气腹后10min．20min较气腹前呼末二氧化碳分压（PET CO2）明显升高．SPO2无明显变化。结论：喉罩全麻是腹腔镜下胆囊切除术的选择之一。     

腹腔镜胆囊切除术中血流动力学变化及监测

腹腔镜胆囊切除术因其独特的优点很快被人们所接受,术中因受麻醉、体位及气腹等因素的影响,血流动力学的变化是很明显的。本文综述了术中血流动力学的变化及其监测。     

喉罩在腹腔镜胆囊切除术麻醉中的应用

喉罩在腹腔镜胆囊切除术麻醉中的应用张玉良都大伟岳云作者单位：７１００５４西安市，解放军第四五一医院麻醉科（张玉良、都大伟）；第四军医大学唐都医院麻醉科（岳云）本文观察腹腔镜胆囊切除术１２０例用喉罩通气的效果并与插管通气同类手术比较。资料与方法喉罩通气...     

Role of laryngeal mask airway in laparoscopic cholecystectomy

Laparoscopic cholecystectomy is one of the most commonly performed surgical procedures and the laryngeal mask airway(LMA) is the most common supraglottic airway device used by the anesthesiologists to manage airway during general anesthesia. Use of LMA has some advantages when compared to endotracheal intubation, such as quick and ease of placement, a lesser requirement for neuromuscular blockade and a lower incidence of postoperative morbididy. However, the use of the LMA in laparoscopy is controversial, based on a concern about increased risk of regurgitation and pulmonary aspiration. The ability of these devices to provide optimal ventilation during laparoscopic procedures has been also questioned. The most important parameter to secure an adequate ventilation and oxygenation for the LMA under pneumoperitoneum condition is its seal pressure of airway. A good sealing pressure, not only state correct patient ventilation, but it reduces the potential risk of aspiration due to the better seal of airway. In addition, the LMAs incorporating a gastric access, permitting a safe anesthesia based on these commented points. We did a literature search to clarify if the use of LMA in preference to intubation provides inadequate ventilation or increase the risk of aspiration in patients undergoing laparoscopic cholecystectomy. We found evidence stating that LMA with drain channel achieves adequate ventilation for these procedures. Limited evidence was found to consider these devices completely safe against aspiration. However, we observed that the incidence of regurgitation and aspiration associated with the use of the LMA in laparoscopic surgery is very low.     

The laryngeal mask airway

A new form of airway has recently been described, which is introduced blindly into the hypopharynx to form a seal around the larynx, so permitting spontaneous or positive pressure ventilation without penetration of the larynx or oesophagus. The further development of this new airway is described and the results of 18 months' clinical experience are presented. The airway was used successfully in 118 patients, 17 of whom received controlled ventilation of their lungs. It was used in place of the facemask in routine anaesthesia, and was of particular value in ophthalmic, dental and ear, nose and throat procedures and where difficulties with the airway were expected. The incidence of sore throat and other problems was low. Experience of more than 500 cases suggests that the laryngeal mask airway may have a valuable r?le to play in all types of inhalational anaesthesia, while its proven value in some cases of difficult intubation indicates that it may contribute significantly to the safety of general anaesthesia.     

SLIPA喉罩和气管插管全麻在腹腔镜胆囊手术中的应用比较

目的 观察SLIPA喉罩与气管插管对患者血流动力学和气道阻力的影响.方法 择期全麻下腹腔镜胆囊手术患者60例,随机均分为SLIPA喉罩组(A组)和气管插管组(B组),记录插入喉罩/气管导管前(T0)、插入喉罩/气管导管后1 min(T1)、3 min(T2)和拔喉罩/气管导管前(T3)、拔喉罩/气管导管后1 min(T4)、3 min(T5)的SBP、DBP、HR和SpO2,同时在8 ml/kg潮气量下监测T1～T3时的平均气道压(Pmean)、气道峰压(Ppeak)和PETCO2,并观察有无反流误吸情况及术后咽喉部并发症.结果 与T0时相比,B组T1、T3、T4时SBP、DBP明显升高,HR明显增快,且相应时点均高于A组(P＜0.05);A组在T1、T2时的Pmean、Ppeak低于B组(P＜0.05);术后咽部不适患者B组(9例)明显多于A组(2例)(P＜0.05).结论 SLIPA喉罩通气用于腹腔镜胆囊手术时,患者应激反应小,术后咽喉部并发症少.     

SLIPA喉罩在烧伤整形手术麻醉中的应用

目的：评估SLIPA喉罩在烧伤整形手术麻醉中的应用效果,并探讨其安全性和有效性。方法：ASAⅠ-Ⅱ级择期瘢痕切除植皮术患者80例,随机均分为SLIPA喉罩组（L组）和气管插管组（T组）,分别记录两组患者在麻醉诱导前、诱导后,插管（喉罩）时、手术开始后10mi n及术毕拔管（喉罩）时的心率（HR）,血氧饱和度（SPO2）,收缩压（SBP）,舒张压（DBP）的变化,记录人工气道建立成功时、成功后30im n及手术结束时的平均气道压（Pmean）、气道峰压（Ppeak）、呼气末二氧化碳分压（PetCO2）和术后咽喉疼痛的病例数。结果：两组均能顺利完成手术,喉罩组和气管插管组在人工气道建立成功时、成功后30im n及手术结束时Pmean、Ppeak、Pet CO2比较,差异均无统计学意义;L组的血流动力学变化明显少于T组,两组比较有显著性差异,术后咽喉痛痛的例数也少于T组。结论：全麻SLIPA喉罩通气用于烧伤整形手术患者优于气管插管,易于维持血流动力学稳定,应激反应轻微,全麻后恢复平稳。     

鼻内窥镜手术患者可弯曲喉罩与一次性双管喉罩气道管理效果比较

目的 观察可弯曲喉罩(flexible laryngeal mask airway,FLMA)与一次性双管喉罩(supreme laryngeal mask airway,SLMA)在鼻内窥镜手术中的气道管理效果,并对二者进行比较. 方法 选取择期行鼻内窥镜手术患者40例.美国麻醉医师协会(ASA)分级Ⅰ～Ⅱ级、年龄20岁～70岁、体重指数＜30 kg/m2.按随机数字表法随机分成两组,分别为FLMA组(F组)及SLMA组(S组),每组各20例.记录麻醉时间、手术时间、喉罩拔除时间(术毕至呼吸恢复正常可以拔除喉罩的时间)和苏醒时间(术毕至呼之睁眼的时间);术毕即刻、术后6、24、36 h咽喉疼痛发生情况;术者满意程度.统计学分析处理采用SPSS 19.0软件完成. 结果 ①两组喉罩首次成功率分别为95％、90％,差异无统计学意义(P＞0.05).②F组置入时间(10.2±1.8)s,S组置入时间(6.3±1.3)s,差异有统计学意义(P＜0.05).③气道压、气道密封压、纤维支气管镜(branchofiberoscope,FOB)检查分级、两组术后拔出喉罩即刻咽喉疼痛发生例数、术后6h咽喉疼痛发生例数差异无统计学意义(P＞0.05).④两组之间手术医生的满意度差异无统计学意义(P＞0.05),但是F组有一个上升的趋势. 结论 ①FLMA与SLMA均可应用于全身麻醉下鼻内窥镜手术的气道管理,安全可靠.SLMA比FLMA更易置入.②FLMA可适用于各类鼻内镜手术,SLMA在涉及到额窦的手术时应用受到一定限制.     

食管引流型喉罩在腹腔镜胆囊手术麻醉中的应用

目的比较食管引流型喉罩(PLMA)和气管插管(IT)在腹腔镜胆囊切除手术中的通气效果,观察气腹前、中、后呼吸力学和血液动力学变化,为临床安全有效的使用喉罩提供参考。方法选择腹腔镜胆囊切除手术病人80例,随机均分为两组,PLMA组和IT组;PLMA组全部应用TOKIBO4号PLMA,沿食管引流管插入14号胃管,IT组应用7·5号气管导管;测定呼吸道密封压,连续监测并记录五个不同时间点的SBP、DBP、HR、SpO2、PETCO2、气道峰压(PIP)、气道阻力(Raw)、胸肺顺应性(CL)。结果PLMA组一次成功率87·5%(34例),二次成功率10%(4例),三次成功率2·5%(2例);IT组一次成功率90%(36例),二次成功率10%(4例)。两组均无失败病例。PLMA组呼吸道密封压平均为(24·50±6·81)cmH2O;气腹前、中、后漏气率差异无显著意义。插入及拔除喉罩或气管导管时,IT组血液动力学变化较PLMA组明显(P<0·05)。两组病人气腹后较气腹前相比:PETCO2、PIP、Raw明显升高(P<0·05);CL明显降低(P<0·05)。结论PLMA通气完全适用于腹腔镜胆囊切除手术,并发症少,安全性和有效性较高。     

食管引流型与标准型喉罩通气道在全身麻醉患者的应用

目的比较食管引流型喉罩通气道(PLMA)和标准型喉罩通气道(SLMA)在全身麻醉患者的应用。方法ASAⅠ~Ⅱ级择期整形外科手术患者60例,随机均分为PLMA组和SLMA组,常规麻醉诱导后,分别插入PLMA或SLMA,并将通气罩充气至60cmH2O。评价两种喉罩通气道的插入特征、气道密封压和漏气部位,记录麻醉诱导前后、喉罩插入时和喉罩插入后5min内SBP、DBP和HR的变化情况。记录麻醉期间发生的呼吸并发症和呼吸道损伤情况。结果PLMA组首次插入即获得满意肺通气的例数高于SLMA组,但PLMA组操作时间明显长于SLMA组(P<0·05)。PLMA组通气罩充气量和气道密封压明显高于SLMA组(P<0·05)。两组插入操作所致的血液动力学反应相似,而且均非常轻微。结论与SLMA相比,PLMA可达到更好的气道密封性,并可提供良好的胃管插入通路,是全身麻醉患者安全有效的呼吸道管理工具之一。     

Efficacy of the ProSeal laryngeal mask airway during manual in-line stabilisation of the neck

The laryngeal mask airway has a potential role during cardiopulmonary resuscitation, but its placement becomes more difficult during manual in-line stabilisation of the neck, and the device cannot reliably prevent pulmonary aspiration. The ProSeal laryngeal mask airway has a theoretical advantage of reducing aspiration because of its drainage tube, but its ease of placement during stabilisation of the neck is unknown. We studied 20 patients to compare ease of placement and the sealing effect between the standard and ProSeal laryngeal mask airways. In a randomised cross-over fashion, after induction of anaesthesia and neuromuscular blockade, the standard and ProSeal laryngeal mask airways were placed in turn. Placement was significantly easier for the ProSeal laryngeal mask airway (successful at the first attempt in 16 patients and at the second attempt in the remaining four patients) than for the laryngeal mask airway (successful at the first attempt in 12 of 20 patients and at the second attempt in three patients, and failed (> two attempts) in the remaining five patients; p = 0.04). The airway pressure at which gas leaked around the device was greater for the ProSeal than the laryngeal mask airway (mean difference 5.8 cmH2O; 95% CI 2.9-8.7 cmH2O; p = 0.0008).