摘要
目的比较喉导管与SLIPA喉罩用于肥胖患者腹腔镜手术气道管理的效果。方法择期腹腔镜胆囊切除术患者60例，年龄40～60岁，性别不限，体重指数〉30kg/m^2，ASA分级I或Ⅱ级，采用随机数字表法，将其随机分为2组（n=30）：喉导管组（I组）和SLIPA喉罩组（Ⅱ组）。两组均靶控输注异丙酚（血浆靶浓度3～5μg／ml）和瑞芬太尼（血浆靶浓度4～6ng／ml），静脉注射罗库溴铵0．6mg／kg，BIS值50-60时置入喉导管或SLIPA喉罩，行机械通气。观察指标：置入前后即刻、拔除前后即刻的HR、MAP；置入时间及次数；纤维支气管镜检查分级（评价置入位置）；气道密封压；术中SpO2、气道峰压（Ppeak）和PETCO2；气道管理失败、术中误吸及咽部不良反应的发生情况。结果与Ⅱ组比较，I组置入时间缩短（P〈0．05）；纤维支气管镜检查分级、气道密封压及咽部不良反应发生率差异无统计学意义（P〉0．05）。两组一次置人成功率均大于90％，术中气道管理失败率为0，未见误吸发生；两组置入前后、拔除前后HR及MAP差异无统计学意义（P〉0．05）；术中SpO2、Ppeak、PETCO2均维持在正常范围。结论喉导管和SLIPA喉罩均可安全有效地用于肥胖患者腹腔镜手术的气道管理，而喉导管更易置人。
Objective To compare the efficacy of laryngeal tube-suction airway （LTSA） and SLIPA laryn- geal mask airway （SLIPA） in obese patients undergoing laparoscopic cholecystectomy. Methods Sixty ASA I or II patients, aged 40-60 yr, with body mass index 〉 30 kg/m^2 , undergomg laparoscopic cholecystectomy, were randomly into 2 groups （ n = 30 each） ：group LTSA （group I ）and group SLIPA （group II ）. Anesthesia was induced with target-controlled infusion （TCI） of propofol with the target plasma concentration （Cp） of 3-5 μg/ml and remifentanil （target Cp = 4-6 ng/ml ）. Rocuronium 0.6 mg/kg was injected intravenously as soon as the patients lost consciousness. LTSA and PLMA were inserted when BIS value was 50-60. HR, mean arterial pressure （MAP）, SpO2, peak airway pressure（Ppeak） and PET CO2 were monitored during operation. Fiberoptic bronchos- copy was performed and the placement was scored. The placement time, the rate of successful placement at first at- tempt, airway sealing pressure, the failure of airway management and side effects were recorded. Results There was iao significant difference in HR, MAP, the fiberoptic bronchoscopy scores, the airway sealing pressure, and the incidence of side effects between the two groups. The placement time was significantly shorter in group I than in group II （ P 〈 0.05 ）. The rate of successful placement at first attempt was more than 90 % and no failure was found in airway management in both groups. The SpO2 , Ppeak, and PET CO2 were within the normal range during operation in both groups. Conclusion Both LTSA and SLIPA can be safely and effectively used in obese patients undergoing laparoscopic cholecystectomy, however, LTSA placement is more easier.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2012年第6期713-715,共3页
Chinese Journal of Anesthesiology
关键词
喉面罩
肥胖症
腹腔镜检查
呼吸
人工
Laryngeal masks
Obesity
Laparoscopy
Respiration, artificial
