喉罩通气全麻在腹腔镜胆囊切除手术中应用.docVIP

喉罩通气全麻在腹腔镜胆囊切除手术中应用 　　【摘要】 目的 比较普通型喉罩(LMA)和气管插管(IT)在腹腔镜下胆囊切除术的应激反应,观察置入喉罩或气管导管的血流动力学变化,观察拔除喉罩或气管导管的血流动力学变化。方法 选择拟行腹腔镜下胆囊切除手术患者60例,随机分为两组LMA组和IT组,LMA组为3或4号普通型喉罩IT组应用7.5或8.0号气管导管,记录插管前,插入后1 min,拔除后1 min的HR、SBP、DBP、结果 插入拔除喉罩或气管导管时,IT组血流动力变化较LMA组明显(P0.05)。结论 LMA全麻通气完全适用腹腔镜下胆囊切除术麻醉,应激反应小及并发症少。 　　【关键词】 喉罩;气管插管;血流动力学;腹腔镜;胆表切除手术;应激反应 　　 　　 Application of laryngeal mask airway ventilation anesthesia in laparoscopic cholecystectomy 　　 　　DING Wei.Department of Anesthesiology,Gaozhou people’sHhospital,Guangdongprovince,525200 China 　　 　　【Abstract】 Objective To comparie the stress response of laryngeal mask airwayand endotracheal intubation during laparoscopic cholecystectomy , and observe hemodynamics change of placement and extraction of laryngeal mask airway or tracheal tube. Methods Sixty paitiens underment laparoscopic cholecystectomy were 　　 　　作者单位:525200高州市人民医院麻醉科 　　 　　 randomly assigned to two groups: in group LMA3 or 4 laryngeal mask airway were selected and in groupIT7.5 or 8.0 tracheal tubes were applied. The HR、SBP and DBPbefore placement ,1 min after placement and 1 mim after extraction were recorded. Results Hemodynamics in group IT were obviously changed more than that in group LMA when placement extraction of laryngeal mask airway or tracheal tube(P0.05).Conclusion LMA ventilation is fully applicable for the general anesthesia of laparoscopic cholecystectomy with small stress rosponse and less complications. 　　【Key words】 Laryngeal mask airway ; Intubation ; Hemodynamic;Laparascope;Cholecystectomy;Stress response 　　 　　腹腔镜下胆囊切除术的麻醉方法常为气管插管全麻和硬膜外麻,硬膜外麻醉高风险并发症多,气管插管全麻存在气道损伤的可能,应激反应较大。本院近来采用喉罩通气全麻的方式完成腹腔镜下胆囊切除术,观察LMA的血流动力学及气管损伤的情况,为临床安全有效的使用气道管理提供新思路。 　　1 资料与方法 　　1.1 一般资料 选择拟行腹腔镜下胆囊切除术患者60例,年龄25～56岁,体质量45～70 kg,ASAⅠ～Ⅱ级,无张口困难和特殊咽喉病史,随机分为两组,LMA组30例,气管插管(IT)组30例,LMA组应用3或4号普通型喉罩,IT组应用7.5或8.0号气管导管。 　　1.2 麻醉方法 患者入室后开放静脉,飞利浦监护仪连续监测无创血压、心电图、脉搏血氧饱和度(SpO2)、呼气末二氧化碳分压(PetCO2)。面罩给氧3 min,常规麻醉诱导用芬太尼4 μg/ kg,阿曲库铵0.5 mg/kg,异丙酚2.0 mg/kg,插入喉罩或气管导管接麻醉机行机械通气,吸入异氟醚维持麻醉,