双管型喉罩在妇科急诊腹腔镜手术中的应用

目的探讨双管型喉罩(PLMA)在妇科急诊腹腔镜手术麻醉中应用的可行性及优越性。方法20例急诊宫外孕腹腔镜手术病人,随机分成两组:喉罩通气组(L组,n=10)和气管插管组(E组,n=10)。全麻醉诱导后,L组置入喉罩,E组行气管内插管。两组均行控制呼吸。在麻醉诱导前(T0)、气管插管(或置喉罩)前(T1)、气管插管(或置喉罩)后即刻(T2)、气管插管(或置喉罩)后通气5min(T3)、20min(T4)、拔管(或拔除喉罩)即刻(T5)、拔管(或拔除喉罩)后5min(T6)分别记录收缩压(SBP)、舒张压(DBP)、HR、SpO2、气道峰压(Ppeak)、潮气量(VT)和呼气末CO2分压(PETCO2),并统计插管或置入喉罩困难例数、术后苏醒时间、术后发生声音嘶哑、咳嗽例数。结果两组的插管时、间歇正压通气5min、20min、拔管时的Ppeak、VT、SpO2、PETCO2、和PaCO2差异无统计学意义(p>0.05)。心率与血压:诱导前后无显著变化;气管插管(或置喉罩)后即刻比较气管插管(或置喉罩)前,L组无显著变化(p>0.05),E组明显增高,且组间比较差异显著(p<0.05);拔管(或拔除喉罩)即刻比较气管插管(或置喉罩)前,L组无显著变化(p>0.05),E组明显增高,且组间比较差异显著(p<0.05)。喉罩留置时间(43.3±9.6)min。术后E组有60%发生咳嗽和挣扎反应,术后24小时发生咽痛者占28%。L组无拔管反应和术后咽痛。结论双管型喉罩置入通气全麻应用于妇科急诊腹腔镜手术安全可行,对循环系统无刺激性影响,无气管插管的刺激症状,与传统的气管内麻醉相比具有显著的优越性。

THE APPLICATION OF PROSEAL LARYNGEAL MASK AIRWAY FOR LAPAROSCOPY OF GYNECOLOGICAL EMERGENCIES

Objective To explore the feasibility and superiority of using Proseal laryngeal mask airway(PLMA)in gynecological emergencies.Methods Twenty ASAI-II patients with emergencies of ectopic pregnancy aged 22~32 years undergoing laparoscopy were divided into two groups of ten each:Proseal laryngeal mask airway group(L)and endotracheal tube group(E).The patients in group L were conducted of PLMA insertion,while those in group E were performed endotracheal intubation with tracheal tube after induction of anesthesia.All the patients were performed controlled-ventilation.SBP,DBP,HR,SpO2,Ppeak,PETCO2,VT,PaCO2 were monitored at seven time-points:before anesthesia(T0),before insertion of tracheal tube and PLMA(T1),at once after insertion of tracheal tube and PLMA(T2),5min(T3),20min(T4)after insertion,extubation(T5)and 5min after extubation(T6).The parameters measured included cases of difficult insertion or intubation,time of analepsia,cases of celostomia and cough.Results Ppeak、VT,SpO2,PETCO2 and PaCO2 remained unchanged before,during and after surgery in both groups(p>0.05).BP and HR at T0 and T1 time points ware similar.BP and HR at T2 and T5 time points increased significantly than that of T0 and T1 time points in group E(p<0.05).BP,HR in group E increased significantly than that in group L at T2 and T5 time points(p<0.05).Bp,HR,at each time point ware similar in group L(p>0.05).SpO2,PETCO2 at the same time point ware similar between the two groups.The retaining time of PLMA was(43.3±9.6)min.The complications after operation included cough(60%),sore-throat(28%)in group E,and there is nothing in group L.Conclusion PLMA can provide the same safe and effective ventilation as tracheal intubation in general anesthesia for gynecological emergencies.Compared with endotracheal intubation,PLMA was easy to use.the stress of patients was low.PLMA avoid the occurrence of complications of pharynxand laryngeal.