70907 Proseal喉罩和气管导管在妇科腹腔镜手术中应用的比较.docVIP

Proseal喉罩和气管导管在妇科腹腔镜手术中应用的比较 曹秀玲　徐铭军　岳剑宁3　尹新芳3　张海燕3 （首都医科大学附属北京妇产医院麻醉科，北京　100026） 【摘要】 目的 观察proseal喉罩用于妇科腹腔镜手术的安全性、有效性和可行性。方法 妇科腹腔镜择期手术60例，ASAI-II级，随机分为喉罩组（L组，30例）和气管导管组（T组，30例）。TCI血浆靶控输注得普利麻PFS和瑞芬太尼，术中调整靶浓度把BIS值维持在50±5范围内。记录心率（HR）、平均动脉压（MAP）、气道峰值压（Pmax）、气道平均压（Pmean）、脉搏血氧饱和度（SPO2％）、呼气末二氧化碳分压（PETCO2）的数值。对两组麻醉药用量、置管（罩）成功率及拔管（罩）期、术后24小时的相关并发症进行比较。 结果 （1）HR、MAP变化：两组间各时间点比较差异无显著性（P＞0.05）。 (2)两组Pmax、Pmean 、PETCO2随体位和气腹的影响变化一致，两组间各时点比较差异无显著性（P＞0.05）。两组的SPO2一直保持稳定水平。（3）两组一、二次置管（罩）和置管（罩）总的成功率基本相同，差异无显著性（P＞0.05）。（4）两组用药量比较：两组麻醉时间、手术时间无显著性差异（P＞0.05），L组麻醉药用量明显小于T组（P＜0.05）。（5）两组并发症比较：拔管（罩）期血压增高、心率增快、恶心呕吐、咽痛、声嘶、咳嗽发生率L组明显低于T组（P＜0.05）；术后24h咳嗽、咳痰发生率L组明显低于T组（P＜0.05），咽痛发生率L组高于T组（P＜0.05）。 结论 Proseal喉罩应激反应小而且可以达到与气管插管相同的气道压和满意的通气效果、术后副作用少。Proseal喉罩应用于妇科腹腔境手术是安全可靠的。 【关键词】Proseal喉罩；妇科腹腔境手术；可行性 Feasibility of Proseal laryngeal mask airway used in gynaecological laparoscopy. Cao Xiu-ling, Xu Ming-jun, YUE Jian-ning,et al. Department of Anesthesiology, Beijing Obstestrics and Gynecologic Hospital, Capital University of Medical Sciences, Beijing 100026, China 【Abstract】 Objective To study the feasibility of LAM-Proseal used in gynecologic laparoscopy. Methods Sixty patients undergoing elective gynaecological laparoscopy were randomly divided into laryngeal mask airway group( L，n=30) and tracheal tube group( T，n=30). With total intravenous anesthesia, the value of BIS maintain to 50±5. HR, interval noninvasive MAP, Pmax, Pmean, SpO2% were recorded. Intubated achievement ratio, extubated and postoperative correlated complication were observated. Results Compared with HR and MAP, there were no difference between two groups(P0.05). Pmax and Pmean were no change in two groups when affected by either body position or IAP(intra-abdominal pressure)(P0.05), but increased when affected by body position and IAP simultaneously (P0.05), there were no difference between two groups(P0.05). Intubated achievement ratio were similar at two groups(P0.05). Compared with operation time and anaesthesia ti