椎管内阻滞复合喉罩全麻腹腔镜手术体会.docVIP

椎管内阻滞复合喉罩全麻腹腔镜手术体会 　　【摘要】目的： 探讨椎管内阻滞复合喉罩全身麻醉在腹腔镜胆囊切除术的麻醉安全性。方法： 腹腔镜胆囊切除术150例随机分为四组，每组30例。单纯气管插管全麻组 （G组） ，单纯喉罩全麻组（L组），椎管内阻滞复合气管插管全麻组（EG组），椎管内阻滞复合喉罩全麻组（EL组）。观察麻醉前、气管插管或喉罩置入时1min、切皮、气腹后5 min、拔出气管导管或喉罩后1min MBP、HR、SpO2 、PETCO2 。并观察插管后、切皮、气腹后各时间气道压力（ Paw）。手术医师在腹腔镜放入腹腔后及手术结束拔出腹腔镜前评估胃膨胀度（ 0～ 3），比较各组麻醉苏醒时间。结果：四组SpO2 均维持98%以上，PETCO235～ 45mmHg。插管时G和EG组血液动力学指标明显增加，L、EL组无显著变化。EL组比基础值低。四组在人工气腹后Paw 均明显增加（ P 005），EG组苏醒时间缩短，EL组最短。肺部并发症EG组发生率最低。麻醉过浅术中知晓发生率和胃膨胀发生率和程度四组相似。结论： 喉罩全麻正压通气可安全有效地用于腹腔镜胆囊切除术患者。椎管内阻滞复合喉罩代替气管插管全麻是腹腔镜胆囊切除术比较理想的麻醉方法，值得临床推广。 　　【关键词】喉罩； 腹腔镜胆囊切除术； 全身麻醉；椎管内阻滞； 　　【Objective】To investigate the safety of intraspinal with laryngeal mask anesthesia in laparoscopic cholecystectomy Methods： A total of 150 cases of laparoscopic cholecystectomy were randomly and equally divided into four groups as general anesthesia group （group G）， laryngeal mask general anesthesia group （group L）， spinal anesthesia combined with tracheal intubation general anesthesia group （group EG）， combined with spinal anesthesia with laryngeal mask anesthesia group （group EL） The values of MBP， HR， SpO2， PETCO2 were determined before anesthesia， 1 min post tracheal intubation or laryngeal mask airway， skin incision， 5 min post pneumoperitoneum， 1 min post pulling out the tracheal catheter or laryngeal mask Airway pressure （Paw） was determined at the time of intubation， skin incision and pneumoperitoneum Assessment of gastric dilatation （0～ 3） was performed in laparoscopic operation in abdominal cavity after operation end and pull out laparoscopic anterior， and anesthesia recovery time of each group was compared Results： SpO2 of all groups were maintained above 98%， and PETCO kept between 235～ 45mmHg At time of intubation， hemodynamic indexes of G and EG increased significantly， and that of L and EL showed no significant changes The EL was lower than the values basis The four groups after the artificial pneumoperitoneum was increased in Paw group （P005）， EG group recovery time shortened， the shortest