喉罩通气用于静脉麻醉下腹腔镜胆囊切除手术.doc

喉罩通气用于静脉麻醉下腹腔镜胆囊切除手术[摘要] 目的：分析探讨喉罩通气替代气管内插管应用于静脉麻醉下腹腔镜胆囊切除手术的可行性和安全性。方法：68例ASAⅠ~Ⅱ级择期行腹腔镜胆囊切除手术患者，采用全凭静脉麻醉。观察记录入室后、诱导后即刻、喉罩置入后即刻BP、HR、血氧饱合度（SpO2）；喉罩置入是否成功，手控呼吸和机械通气下检查有无漏气；记录气腹前后呼气末二氧化碳分压（PetCO2）、气道压力（Paw）、潮气量（Vt）的变化；麻醉后的恢复情况以及术后调查患者有无术中知晓。结果：有4例因喉罩周围漏气严重而致喉罩通气失败，其余64例患者喉罩置入顺利，手控呼吸和机械通气下无漏气现象，顺利完成手术；Paw气腹后较气腹前明显增加，Vt变化不明显，PetCO2仅轻度增加，调整呼吸参数后恢复；患者血流动力学变化不显著；麻醉后苏醒迅速恢复平稳，对手术过程无记忆，无术后不良反应。结论：应用喉罩通气全凭静脉麻醉在加强监测下可安全用于腹腔镜胆囊切除手术患者。 [关键词] 喉罩；静脉麻醉；腹腔镜；胆囊切除 [中图分类号]R614 [文献标识码]A [文章编号]1673-7210（2007）06（b）-018-02 Application of laryngeal mask airway in total intravenous anesthesia for laparoscopic cholecystectomy ZHOU Guo-qing (Department of Anesthesia, Pinggu District Hospital, Beijing 101200,China) [Abstract]Objective: To evaluate the safety and feasibility of laryngeal mask airway(LMA) in total intravenous anesthesia for laparoscopic cholecystectomy.Methods: 68 ASA I or II patients scheduling for laparoscopic cholecystectomy employing total intravenous LMA anesthesia were involved. Blood pressure (BP), heart rate (HR) and pulse oxygen saturation (SpO2) were observed and recorded at patients entering operation room, anesthesia induced and LMA placed respectively. Whether LMA placed successfully and air leakage were evaluated. End-tidal partial pressure of carbon dioxide (PetCO2), airway pressure (Paw) and tidal volume (Vt) were recorded before and after pneumoperitoneum. Intraoperative awareness and recovery form anesthesia were investigated.Results: It was abortive to place laryngeal mask airway for 4 patients. Laryngeal mask airways were placed successfully without air leakage when controlled ventilation in 64 patients. After pneumoperitoneum Paw was increased significantly. The variation of Vt was stable. Pneumoperitoneum caused a little increase in PetCO2 which recovered normal after modified respiratory parameters. Hemodynamic parameters were stable during anesthesia. All patients recovered smoothly and rapidly after operation. None had intraoperative awar