腹腔镜手术患者CLMA喉罩、SLIPA喉罩与PLMA喉罩气道管理的效果

目的 比较经典型喉罩(CLMA喉罩)、SLIPA喉罩和食管引流型喉罩(PLMA喉罩)用于腹腔镜手术患者气道管理的效果.方法 择期行腹腔镜手术患者123例,年龄20～64岁,ASA分级Ⅰ或Ⅱ级,随机分为3组:CLMA组(C组,n=41)、SLIPA组(S组,n=42)和PLMA组(P组,n=40).麻醉诱导后置入喉罩,行间歇正压通气.测定气道密封压后实施气腹.评估喉罩置入难易性.记录首次喉罩置入情况、喉罩置入时间、麻醉恢复时间和不良反应的发生情况.于气腹前及气腹压至12 mm Hg时记录气道吸气峰压(PIP)及气道密封压＜PIP的发生情况.结果 C组有1例患者更换喉罩型号后置入成功,其余患者均首次喉罩置入成功,组间比较差异无统计学意义(P＞0.05).与C组比较,S组喉罩置入时间和麻醉恢复时间缩短,喉罩置入容易,P组喉罩置入时间延长,气道密封压升高,气道密封压＜PIP的患者减少(P＜0.05).与S组比较,P组喉罩置入时间和麻醉恢复时间延长,喉罩置入稍难,气道密封压升高,气道密封压＜PIP的患者减少(P＜0.05).与气腹前比较,各组气腹至12 mm Hg时PIP升高(P＜0.05).三组患者不良反应发生率比较差异无统计学意义(P＞0.05).结论 CLMA喉罩、SLIPA喉罩和PLMA喉罩均可保证有效通气,不良反应少.SLIPA喉罩置入更简单,而PLMA喉罩气道密封效果好,更适用于腹腔镜手术患者.

Efficacy of laryngeal mask airway Classic, Streamlined Liner of Pharyngeal Airway and laryngeal mask airway ProSeal in patients undergoing laparoscopic surgery

Objective To compare the efficacy of the laryngeal mask airway Classic (CLMA), Streamlined Liner of Pharyngeal Airway (SLIPA) and laryngeal mask airway ProSeal (PLMA) in patients undergoing laparoscopic surgery. Methods One hundred and twenty-three ASA Ⅰ or Ⅱ patients aged 20-64 yr undergoing elective laparoscopic surgery were randomly divided into 3 groups: CLMA group (group C, n =41 ), SLIPA group (group S, n =42) and PLMA group (group P, n =40). Laryngeal mask was inserted after induction of anesthesia with sufentanil 0.3 μg/kg, atracurium 0.5 mg/kg and propofol 2 mg/kg. Mll the patients were ventilated with intermittent positive-pressure ventilation. Anesthesia was maintained with contiunous infusion of propofol 6-8 mg· kg-1· h-1 and with supplementary administration of sufentsnil 0.1-0.2 μg/kg and atracurium 0.2 mg/kg as required. The degree of difficulty in inserting the laryngeal mask was evaluated. The rate of successful placement at first attempt, device placement time, recovery time and complications were recorded . Peak inspiratory pressure (PIP) and the number of patients with an airway sealing pressure less than PIP were recorded before pneumoperitoneum and when intra-abdominal pressure achieved 12 mm Hg. Results The placement was easier and the placement time and recovery time were significantly shorter in group S, and the placement time was significantly longer,the airway sealing pressure was significantly higher and the number of patients with an airway sealing pressure less than PIP was lower in group P than in group C ( P ＜ 0.05). The placement time and recovery time were significantly longer, the placement was harder, the airway sealing pressure was significantly higher, and the number of patients with an airway sealing pressure less than PIP was lower in group P than in group S ( P ＜ 0.05). PIP was significantiy higher when intra-abdominal pressure achieved 12 mm Hg than that before pneumoperitoneum in all the three groups ( P ＜ 0.05). There was no significant difference in the incidence of complications and rate of successful placement at first attempt among the three groups ( P ＞ 0.05). Conclusion All the three airway devices can provide adequate ventilation during operation, with fewer complications. SLIPA placement is easiest. PLMA can assure good airway sealing and is most suitable for patients undergoing laparoscopic surgery.