Supreme喉罩在妇科腹腔镜手术麻醉中的可行性

目的 研究Supreme喉罩在妇科腹腔镜手术中的安全性、有效性以及不良反应的发生情况.方法 回顾2009年10月至2010年4月在北京大学第一医院行妇科腹腔镜手术全身麻醉患者125例,使用喉罩(S组)69例和使用气管插管(T组)56例.记录患者插管(罩)和拔管(罩)前后的心率(HR)和血压(MAP)的变化,记录插管(罩)后和气腹后气道峰压(Ppeak)和呼气末二氧化碳分压(PETCO2)的变化.记录患者围术期不良反应的发生情况.结果 与基础值相比,T组HR和MAP在插管即刻和拔管期间均升高(P＜0.05).与T组比较,S组在插管即刻和拔管即刻的HR和MAP明显降低(P＜0.01).两组患者Ppeak和PET.CO2随麻醉和气腹的影响一致,组间比较各时间点差异无统计学意义(P＞0.05).插管(罩)期两组均无体动和呛咳出现,拔管(罩)期S组体动、呛咳和咽痛等不良反应发生率明显少于T组(P＜0.05).结论 妇科腹腔镜手术中Supreme喉罩可以达到与气管插管相同的安全有效的通气效果,并且对血流动力学影响小,不良反应少.

The feasibility of Supreme laryngeal mask airway in gynecological laparoscopy surgery

Objective To explore the safety, efficacy and side effect of Supreme laryngeal mask airway (LMA) used in gynecological laparoscopy. Methods From Oct 2009 to Apr. 2010 in First Hospital of Peking University, 125 patients undergoing general anesthesia for elective gynecological laparoscopy were reviewed, 69 of which were dealt with Supreme LMA (S) and 56 with endotracheal tube (T). After anesthesia induction, changes of HR and MAP were observed during intubation and extubation.The peak inspiratory airway pressure ( Ppeak ) and PETCO2 were monitored. Relevant perioperative side effects were recorded. Results HR and MAP in group T were increased right after intubation and during extubation (P ＜ 0. 05 ), which were significantly decreased in group S (P ＜ 0. 01 ). Ppeak and PETCO2 were comparable in the two groups at all the time points ( P ＞ 0. 05 ). There was no body movement or coughing at the time of intubation. Group S had less incidence of body movement, coughing and sore throat than group T during extubation (P ＜ 0. 05). Conclusion Supreme LMA can provide the same safe and effective ventilation as intubation and less stress response and side effects in gynecological laparoscopy.