摘要
目的比较腹腔镜胆囊切除术(LC)中SLIPA喉罩与气管插管(ETT)使用对心血管和气道反应的影响,探讨SLIPA喉罩在LC气道管理的安全性和有效性。方法 98例LC包括喉罩麻醉患者50例(SLIPA组)和气管插管麻醉患者48例(ETT组)。全麻诱导后分别记录5个时间点插管(罩)前(T0)、插管(罩)即刻(T1)、插管(罩)后5 min(T2)、拔管(罩)后即刻(T3)和拔管(罩)后5 min(T4)的心率(HR)、收缩压(SBP)、舒张压(DBP)和平均动脉压(MAP),以及脉搏氧饱和度(SpO2)和呼气末二氧化碳分压(PetCO2),以及气腹前即刻、气腹后10 min、气腹结束前即刻和气腹结束后10 min的平均气道压(Pmean)和气道峰压(Ppeak)。观察术后拔管时有无血迹,患者有无躁动、呛咳、咽喉疼痛、恶心呕吐、声音嘶哑等不良反应。结果 SLIPA组患者在T1、T2、T3和T4时间点血液动力学指标相对平稳,SBP、DBP、MAP和HR均低于ETT组(P<0.05),气腹前即刻、气腹后10 min和气腹结束前即刻的Pmean和Ppeak也明显低于ETT组(P<0.05)。组内比较结果显示,与T0时间点比较,ETT组T1、T2、T3和T4时间点的SBP、DBP和MAP升高明显(P<0.05),而SLIPA组差异无统计学意义(P>0.05)。2组患者气腹后10 min和气腹结束前即刻的Pmean和Ppeak明显高于气腹前即刻(P>0.05)。各监测时间点PetCO2和SpO2均在正常范围,2组间差异无统计学意义(P>0.05)。而SLIPA组患者不良反应的发生率显著低于ETT组,2组间差异有统计学意义(P<0.05)。结论 SLIPA喉罩通气用于腹腔镜胆囊切除术,血流动力学相对稳定,咽喉及气道的刺激反应低,术后咽部不良反应较少,具有较好的安全性和有效性。
Objective To discuss the feasibility and security of SLPA laryngeal mask via observing the impact of SLIPA laryngeal mask airway and endotreacheal intubation （ETT） on cardiovascular and airway reactivity in laparoseopic cholecystectomy （LC）. Methods General anesthesia patients scheduled for selective LC were divided into two groups, SLIPA group （50 cases） and ETF group （48 cases）. SBP, DBP, MAP, HR, PetCO2 and SpO2 were recorded at 5 time points, including before intubation （TO）, intubation （T1）, 10 min after intubation （T2）, extubation （T3）, and 10 min after extubation （T5）. Airway peak pressure （Ppeak） and mean pressure airway （Pmean） were measured at pre-pneumoperitoneum immediately, after 10min, the end of the pneumoperitoneum immediately, and after 10 rain the end of the pneu- moperitoneum. The availability of intraoperative aspiration of reflux and postoperative throat complications were also observed. Results The hemodynamic indexes of patients in SLIPA group, which included SBP, DBP, MAP and HR, were relatively stable at time points of T1, T2, T3 and T4, and the indexes in SLIPA group were lower than those in EIT group （P 〈0.05）. SBP, DBP, and MAP in ETI＂ group at TI, T2, T3, and T4 increased significantly than that at TO （P 〈0.05）. Ppeak and Pmean of SLIPA group were also lower than those in ET1p group at pre-pneumoperitoneum immediately, after 10min, and the end of the pneumoperitoneum immediately （P 〈0.05 ）. Pmean and Ppeak in two groups after 10 min and in the end of the pneumoperitoneum immediately increased significantly than that at pre-pneumoperitoneum immediate- ly （P 〈0.05）. However, there were no significant differences between different time points in SLIPA group （P 〉0.05）. PetCO2 and SpO2 at each time point were within normal range, and there was no significant difference between two groups （P 〉0.05）. On the other hand, the incidence of adverse reactions in SLIPA group was significantly lower than that in ETI＂
出处
《安徽医学》
2013年第6期766-768,共3页
Anhui Medical Journal
关键词
SLIPA喉罩
气管插管
腹腔镜
胆囊切除术
全身麻醉
SLIPA laryngeal mask
Endotracheal intubation
Laparoscopy
Cholecysteetomy
General anesthesia
