SLIPA喉罩在留置胃管的腹腔镜胆囊切除术全麻患者中的应用研究

目的研究SLIPA喉罩对留置胃管的腹腔镜胆囊切除术全麻患者PaCO2、PetCO2、气道压及漏气率、胃胀气等的影响,评估SLIPA喉罩用于该类患者的安全性、有效性及相关注意事项。方法 90例全麻腹腔镜胆囊切除术患者,随机均分为气管内插管组(Ⅰ组)、SLIPA喉罩组(Ⅱ组)和留置胃管使用SLIPA喉罩组(Ⅲ组)。记录气腹前即刻(T0)、气腹后10 min(T1)、气腹后20 min(T2)、气腹结束前即刻(T3)、气腹结束后5 min(T4)、气腹结束后15 min(T5)时患者的气道峰压(Ppeak)、平均压气道(Pmean)、呼气末二氧化碳分压(PetCO2)、动脉血二氧化碳分压(PaCO2)。并测定喉罩植入后即刻气道密封压,观察术中漏气率,评估胃胀气程度。结果气道密封压Ⅱ、Ⅲ组均能满足通气要求,组间无差异;Ppeak、Pmean各时点Ⅱ组和Ⅲ组较Ⅰ组低(P<0.05),Ⅱ、Ⅲ组间无差异;三组PetCO2、PaCO2各时点无差异;漏气率Ⅱ、Ⅲ组较Ⅰ组高,Ⅱ、Ⅲ组间差异无统计学意义;三组间胃胀气评分差异无统计学意义。Ⅰ组有18例患者术后随访有咽痛,Ⅱ、Ⅲ组各3例患者术后随访有轻度咽痛(P<0.01)。结论 SLIPA喉罩可安全应用于留置胃管的腹腔镜胆囊切除术全麻患者。

The application of SLIPA laryngeal mask airway in indwelling gastric tube in anesthesia for laparoscopic cholecystectomy patients

Objective To investigate the effect of the SLIPA laryngeal mask on indwelling stomach tube laparoscopic re- section of general anesthesia in PETCO2,PaCO2,airway pressure and leak rate,bloating of patients. Assessment the SLIPA laryngeal mask airway for the security, effectiveness, and related considerations of such patient. Methods All 90 cases of general anesthesia laparoscopic cholecystectomy were randomly divided into the endotracheal intubation group （ Ⅰgroup）, SLIPA laryngeal mask group （ Ⅱ group） and indwelling stomach tube for SLIPA laryngeal mask group （m group）.Reeorded airway peak pressure （Ppeak）,mean pressure airway （Pmean）, end-tidal carbon dioxide partial pressure （PetCO2）, arterial carbon dioxide tension （PaCO2） of patient pre-pneumoperitoneum immediately （T0）, after lOmin （T1） and 20 min （T2）, the end of the pneumoperitoneum immediately （T3） after the end of the pneumoperitoneum 5 min（T4）, 15 min （T5）.And the determination of the laryngeal mask implanted immediately after airway sealing pressure, intraoperative air leakage rate, to assess the extent of bloating in accordance. Results The sealing of airway pressure Ⅱ , Ⅲ groups were able to meet the ventilation requirements, there was no significant difference between groups;Group Ⅱ and group Ⅲ of Ppeak, Pmean at each time point was decreased than group I （P 〈0.05）, group Ⅱ and group Ⅲ had no difference;Between three groups Pet- CO2 and PaCO2 had no difference at each time point;leakage rate had no significant gap between the group H and group m ;bloating score had no significant differences among the three groups.18 patients of group I had sore throat with post- operative follow-up, three cases the patients of Group Ⅱ , Ⅲ were a mild sore throat after post-operative followed-up （P 〈 0.01 ）. Conclusion SLIPA laryngeal mask can be safely used indwelling gastric tube during laparoscopic cholecystectomy anesthesia patients.