剖宫产手术SLIPA通气道和气管插管的效果比较

目的探讨SLIPA通气道用于剖宫产手术全麻的安全性和可行性。方法足月单胎妊娠行剖宫产手术产妇50例，随机分为SLIPA组（S组）和气管插管组（T组），每组各25例。观察插管前后、拔管前后各时间点的平均动脉压（MAP）、心率、呼气末二氧化碳分压（PETCO2）、气道峰压（Paw）的变化；观察插管或置入SLIPA通气道时、拔除前后及术中是否出现呛咳、体动、反流、呕吐、误吸等情况。分别在两组产妇胎儿娩出时抽取脐动、静脉血，进行血气分析。记录两组麻醉诱导至胎儿娩出时间（I-D）、手术时间、新生儿1min和5min Apgar评分。结果S组首次置管成功率为100％，T组有2例再次插管后成功。术中S组有3例出现轻度漏气，不影响呼吸管理。S组心率、MAP比较平稳，插管后2min和拔管后2min与T组比较差异均有统计学意义（P〈0．05）。两组产妇术中均未发生体动、呛咳、呕吐、反流、误吸；但拔管时，T组有17例发生呛咳、体动，术后2、24h咽痛发生例数T组分别为10例和6例，而S组均无拔管反应和术后咽痛，两组比较差异均有统计学意义（P〈0．05）。两组I—D、新生儿1min和5min Apgar评分比较，差异均无统计学意义（P〉0．05）。两组新生儿脐动、静脉血pH值、CO2分压、氧分压比较，差异均无统计学意义（P〉0．05）。结论SLIPA通气道较气管插管对母婴生理功能影响小，术后并发症少，可安全用于剖宫产手术麻醉。

Comparison of the SLIPA mask airway and endotracheal intubation in the cesarean section operation under general anesthesia

Objective To observe the safety and efficacy of the SLIPA mask airway in the cesarean section operation under general anesthesia. Methods Fifty single birth pregnant women who underwent cesarean operation under general anesthesia were randomized into 2 groups. SLIPA mask group （group S, 25 cases） and endotracheal intubation （ETT） group （group T, 25 cases）. Mean arterial pressure （MAP）, heart rate （HR）, partial pressure of carbon dioxide in end expired gas （PETCO2）, peak airway pressure （Paw） were measured before induction of anesthesia, just before intubation, 2 min after intubation, just before extubation, 2 min after extubation. Bucking, style, reflow, vomiting, aspiration were observed at intubation or SLIPA mask airway insertion, before and after extubation and intraoperative. Umbilical arteries and veins blood were collected at delivery for the blood gas analysis. All delivery times, operation time and Apgar scores at 1, 5 min were recorded. Results The successful rate of the first time intubation was 100% in group S, there was 2 cases by the second time intubation in group T. There was 3 cases with gently air leak, but no influence on respiratory management. After intubation anti extubation, MAP and HR increased significantly in group T （P 〈 0.05）, while group S had no significant change. There was no occurrence of bucking, style, reflow, vomiting, aspiration intraoperative, but 17 cases occurred at extubation in group T. The incidence and degree of sore throat in group T （10 cases after 2 hours and 6 cases after 24 hours） were significantly higher than those in group S （P 〈 0.05 ）. The Apgar scores at 1, 5 rain and delivery times were not significant between the two groups （P 〉 0.05 ）. Conclusion There is less adverse effects of SLIPA mask airway than ETT under zeneral anesthesia in the cesarean section operation, SLIPA mask airway is safe and efficacious.