Supreme喉罩用于腹腔镜手术患者气道管理的效果

目的 评价Supreme喉罩用于腹腔镜手术患者气道管理的效果.方法 择期全麻下行腹腔镜手术的患者120例,性别不限,年龄35～60岁,体重48～85 kg,ASA Ⅰ或Ⅱ级,Mallampatis Ⅰ～Ⅲ级,随机分为2组(n=60):Supreme喉罩组(S组)和气管插管组(T组).S组根据患者体重选择喉罩型号,麻醉诱导后置入喉罩,并经引流管放置胃管,T组在直接喉镜下行气管插管.记录气管插管或喉罩置入时间及置人情况;记录S组胃管置入状况和喉罩气道密封压,并行纤维支气管镜检查评分,以评价喉罩对位情况;记录术中SpO2、PrrCO2和气道峰压(Ppeak),记录拔除气管导管或喉罩后不良反应的发生情况;记录手术时间、麻醉时间、拔管时间和苏醒时间.结果 与T组比较,S组喉罩置入时间、拔管时间和苏醒时间缩短,拔除喉罩后低氧血症、呛咳、咽喉痛的发生率降低(P<0.05);两组均无返流误吸发生.各时点spO2、PETCO2、Ppeak均在正常范围内,组间比较差异无统计学意义(P>0.05).S组喉罩置入成功率和T组气管插管成功率比较差异无统计学意义(P>0.05),S组喉罩气道密封压为(25±4)cm H2O,喉罩对位准确率95%,胃管放置成功率100%.结论 Supreme喉罩通气效果好,气道密封性可靠,拔除后不良反应少,可安全有效地用于腹腔镜手术患者的全麻气道管理.

Efficacy of laryngeal mask airway Supreme in patients undergoing laparoscopic surgery

Objective To assess the efficacy of laryngeal mask airway Supreme (LMA Supreme) used in patients undergoing laparoscopic surgery. Methods One hundred and twenty ASA I or Ⅱ patients of both sexes aged 35-60 yr weighing 48-85 kg undergoing elective laparoscopic surgery were randomized to 2 groups ( n = 60 each): LMA Supreme group (group S) and tracheal intubation group (group T). Mallampati test was performed before operation in both groups. The patients were classified as I - Ⅲ . In group S the LMA Supreme was inserted after induction of anesthesia with sufentanil 0.2 fig/kg, propofol 2-3 mg/kg and vecuronium 0.1 mg/kg. A gastric tube was inserted through the drain tube of the LMA Supreme. In group T the patients were intubated under direct laryngoscopy. The success rate, LMA placement/intubation time, success rate of gastric tube placement, airway seal pressure, SpO2, PETCO2 , peak airway pressure and complications (hypoxemia, nausea and vomiting, choking hoarseness, sore throat and regurgitation of gastric contents) were recorded. The duration of surgery, anesthesia time, extubation time and emergence time were also recorded. Results There was no significant difference in the success rate between the two groups. The placement and removal time and recovery time were significantly shorter in group S than in group T. The airway seal pressure was (25 ±4) cm H2O in group S. SpO2, PETCO2 and peak pressure were within normal range in both groups. The incidence of postoperative hypoxemia, choking and sore throat were significantly lower in group S than in group T. Conclusion LMA Supreme can provide adequate ventilation during operation with less complications and can be used effectively for laparoscopic surgery.