SLIPA喉罩在妇科腹腔镜手术麻醉中的应用

目的比较流线形尾管的咽部气道(SLIPA)喉罩与传统的气管插管对妇科手术麻醉的效果和安全性的影响。方法择期行妇科腹腔镜手术的患者40例,随机分为SLIPA喉罩组(S组)和气管插管组(T组),每组20例。两组患者均采用静-吸复合全麻,监测并记录两组患者入室后(T0)、麻醉诱导后(T1)、置入SLIPA喉罩或气管导管即刻(T2)、气腹1 min后(T3)、拔管(罩)时(T4)的收缩压(SDP)、舒张压(DBP)、心率(HR)、脉搏血氧饱和度(SpO2)、呼气末二氧化碳分压(PETCO2)等指标;记录拔除喉罩或气管导管后患者躁动、呛咳、咽痛、声音嘶哑和胃内容物的反流误吸情况。结果两组患者在入室后(T0)、麻醉诱导后(T1)、气腹1 min后(T3)的SBP、DBP和HR的变化组间比较差异无统计学意义;在置入喉罩或气管导管即刻(T2)、拔管(罩)时(T4)的SBP、DBP、HR变化有显著性,T组明显高于S组(P<0.05)。两组患者术中及术后均无反流误吸的发生,但是插、拔管(罩)时出现躁动、呛咳的例数T组明显多于S组(P<0.05)。两组患者术中及术后均无反流误吸的发生,但是插、拔管(罩)时出现躁动、呛咳的例数T组明显多于S组(P<0.05)。结论与气管插管相比,SLIPA喉罩具有操作简单,能维持呼吸通畅,保证有效通气,对呼吸、循环系统影响小,并发症少等优点,可以安全地应用于妇科腹腔镜手术的麻醉。

The application of SLIPA laryngeal mask airway in anesthesia for laparoscopic operation in patients from department of gynecology

Objective To compare the difference between SLIPA laryngeal mask airway（LMA） and endotracheal intubation（ET） in safety and anesthetic effect of anesthesia for laparoscopic operation in patients from department of gynecology.Methods Forty female patients in department of gynecology undergoing laparoscopic operation were randomly allocated into SLIPA LMA group（n = 20） and ET group（n = 20）.Combined intravenous and inhalant general anesthesia were performed in all patients.Parameters including systolic blood pressure（SBP）,diastolic blood pressure（DBP）,heart rate（HR）,pulse oxygen saturation（SpO2）,and end-tidal carbon dioxide pressure（PETCO2） were monitored and recorded at the time when patients entered into operation room（T0）,the induction of anesthesia was finished（T1）,SLIPA LMA or ET tube was just inserted（T2）,one minute after artificial pneumoperitoneum was established（T3）,and SLIPA LMA or ET tube was removed（T4）.Adverse events including agitation,severe coughing,sore throat,hoarseness,regurgitation and aspiration were recorded.Results There was no difference in SBP,DBP,and HR at the time point of T0,T1,and T3 between two groups,whereas values of SBP,DBP,and HR in SLIPA LMA group were significantly lower than those of ET group at the time point of T2 and T4（P 〈 0.05）.Regurgitation and aspiration were not happened in these two groups.More patients with agitation or severe coughing were found in ET group than those of SLIPA LMA group（P 〈 0.05）.Conclusion Compared with ET,SLIPA LMA has more advantages including easier operation,good airway,effective ventilation,milder influence on respiratory or cardiovascular system,and fewer complications.It is safe to use SLIPA LMA in anesthesia for laparoscopic operation in patients of department of gynecology.