不同喉罩在甲状腺手术全身麻醉中的应用

目的比较I-gel喉罩与Supreme喉罩在全身麻醉甲状腺手术中的气道管理效果。方法全身麻醉下择期行甲状腺手术患者100例，ASAI-Ⅱ级，随机分为I—gel喉罩组（I组，n=50）与Supreme喉罩组（S组，n=50）。记录喉罩置入前、后1、3、5min的血流动力学变化及喉罩置入后（To）、手术开始时（T1）、术中牵拉甲状腺（T2）、及肿瘤切除后（T，）各时点的脉搏、氧饱和度（SPO2）、气道峰压（Ppeak）及口咽漏气情况的变化。记录喉罩气道密封压及纤支镜检查评级。记录术毕拔除喉罩的不良反应。结果两组患者各时点血流动力学、SPO2无差异（P〉0．05）。与I组相比，T2时点S组Ppeak明显增高（P〈0．05）；口咽部漏气患者增多（P〈0．05）。I组喉罩气道密封压（28±3）cmH2O明显高于S组（24±4）cmH2O（P〈0．05），纤支镜检查评级I组优于S组（P〈0．05）。结论I-gel喉罩通气效果好，术中气道密封性更高，可安全有效的应用于全身麻醉甲状腺手术的气道管理。

Comparison of I-gel with supreme laryngeal mask in thyroid surgery under general anesthesia

Objective To compare the effects of the I-gel Laryngeal mask with the Supreme Laryngeal mask on airway management of patients during thyroid surgery under general anesthesia. Methods 100 patients with ASA I - II undergoing selective thyroid surgery under general anesthesia were identified and randomized to I-gel （ Group I, n = 50） and Supreme （ Group S, n = 50） group. The hemodynamic changes were recorded at the time before insertion and 1,3,5min after insertion The MAP and HR . The SPO2 ,Ppeak and Oropharyngeal leakage were recorded after la- ryngeal mask insertion（ TO ）,at the beginning of operation （T1 ）,at the time of intraoperative traction of the thyroid （ T2 ） and after resection of the thyroid gland （ T3 ）. We also recorded the airway sealing pressure and rating of fiber endoscopy, as well as adverse reactions after the removal of Laryngeal mask. Results There were no significant differ- ences in WAP, HR and SPO2 between the two groups. At the time of T2, the Ppeak were higher, and more patients with oropharyngeal leakage were in groupS than that in group I （ P 〈 0.05 ）. The airway sealing pressure in group I （28 ＋ 3 cmI-I20 ） was higher than that in group S （24 ＋ 4cmH2 O） （ P 〈 0.05 ）, and the rating of fiber endoscopy was better in group I than group S （ P 〈 0.05 ）. Conclusion The I-gel laryngeal mask airway works well, with higher airway sealing pressure ,which is safe and effective when used in airway management during the thyroid operation under general anes- thesia.