双管喉罩在妇科腹腔镜手术的临床应用.docVIP

双管喉罩在妇科腹腔镜手术的临床应用 【摘要】目的：喉罩［LMA］（第三代）通气代替气管内插管全麻，更适用于快速的妇科腹腔镜手术。方法： 选择ASAI-Ⅱ级择期手术病人50例。手术种类：卵巢囊肿剥离术、盆腔粘连松解术、宫外孕手术。盲插LMA成功后，常规麻醉维持。结果：LMA放置及术中循环、呼吸功能均稳定，术前、术中、术后MAP、HR、PEtCO2无明显差异（P＞0.05），术中未发现胃内物返流。结论：LMA全麻期间的维持通气的主要优点为置管方便，不会引起明显的心血管反应，对肺通气无影响。与气管插管全麻比较，更适用于快速的妇科腹腔镜手术。 【关键词】 喉罩；妇科腹腔镜手术 ;应用 Clinical Application of LMA-ProSeal in Gynaecological Laparoscopic Surgerry WＡＮＧ Min， XＩＥ Lin－bi, WＡＮＧ Ying－guang The Peoples Hospital of Gaoming in Foshan, Guangdong Foshan 528500, China Abstract：Objective: To study the effects of laryngeal mask airway(LMA) general anesthesia, compare to the common endotracheal general anesthesia , which is better in fast and transient gynaecological laparoscopic surgery .Methods: To elect 50 selective operation patients (ASA Ⅰ-Ⅱ).surgery categery:oophorocystectomy,lysis of pelvic adesions, exfetation surgery . inserted the LMA successful,given convention maintenance of anesthesia.Results:The time of placing and during the operation ,the circulatory and respiratory are also stabilization.before operation,during operation and after operation,the MAP HR PEtCO2 were no significant disparity(P0.05).gastric contents were not found backstreaming. Conclusions: To compare common general anesthesia ,the main advantages are the following:to place simply,not to cause significant cardiovascular effects, not to contribute lung ventilation,the last,the LMA is more suitable in fast and transient gynaecological laparoscopic surgery. Key words: LMA-ProSeal; Gynaecological laparoscopic surgery 喉罩(LMA)通气与气管全麻内插管相比较，喉罩刺激小，呼吸道机械性梗阻少，插入和拔出心血管系统反应较小，术后较少发生咽喉痛。普通喉罩（第一代、第二代 ）存在返流误吸的风险，双管喉罩即第三代喉罩有一通道与食道相通，安全得到了保障。 1 资料与方法 1.1 一般资料: ASAI-Ⅱ级择期手术病人50例，年龄18～45岁，平均31.2±5岁，体重43～65kg，平均53±7.3kg，手术种类：卵巢囊肿剥离术，盆腔粘连松解术，宫外孕手术。 1.2 麻醉方法:入室后监测HR、MAP、PEtCO2、SPO2。诱导：咪唑安定0.08mg/kg，异丙酚2mg/kg，芬太尼4ug/kg,维库溴胺0.12mg/kg,盲插LMA，成功后连接Drager麻醉机Fabius行IPPV，MV100～120ml/kg.min,RR10～12次/分，Paw1.15～1.71kPa，吸入0.8～1.5%lsoflurane，微泵入异丙酚1～3mg/kg.h瑞芬太尼0.08～0.1ug/kg.min间歇注入维库溴铵。 1.3 统计分析: 计量资料以均数±标准差(±s