CAJ | 학술논문

目的通过观察患者循环和呼吸参数变化及并发症情况,探讨第三代喉罩(PLMA)在腹腔镜胆囊切除术中应用的安全性.方法 60例择期腹腔镜胆囊切除术患者,随机分为气管捕管全麻(ETT)、普通喉罩全麻(LMA)、第三代喉罩全麻(PLMA)三组;观测记录三组患者插管前、后1 min的HR,SBP,DSP和正压通气15 min和气腹15 min时的分钟通气量(MV)、潮气量(TV)、气道峰(Ppeak)和P<,ET>CO<,2>;记录三组患者各种并发症发生例数.结果血流动力学改变表现为ETT组插管前、后有明显区别,插管后ETT组和LMA组、PLMA组间有明显区别;三组患者正压通气15 min和气腹15 min时的分钟通气量(MV)、潮气量(TV)、气道峰压(Ppeak)和P<,ET>CO<,2>均有明显差异,组间无差异;LMA组胃肠道胀气严重,漏气例数比PLMA组明显增加.结论第三代喉罩适用于腹腔镜胆囊切除手术,安全有效,可避免气管插管和普通喉罩引起的并发症,值得推广应用.
목적 통과관찰환자순배화호흡삼수변화급병발증정황,탐토제삼대후조(PLMA)재복강경담낭절제술중응용적안전성.방법 60례택기복강경담낭절제술환자,수궤분위기관포관전마(ETT)、보통후조전마(LMA)、제삼대후조전마(PLMA)삼조;관측기록삼조환자삽관전、후1 min적HR,SBP,DSP화정압통기15 min화기복15 min시적분종통기량(MV)、조기량(TV)、기도봉(Ppeak)화P<,ET>CO<,2>;기록삼조환자각충병발증발생례수.결과 혈류동역학개변표현위ETT조삽관전、후유명현구별,삽관후ETT조화LMA조、PLMA조간유명현구별;삼조환자정압통기15 min화기복15 min시적분종통기량(MV)、조기량(TV)、기도봉압(Ppeak)화P<,ET>CO<,2>균유명현차이,조간무차이;LMA조위장도창기엄중,루기례수비PLMA조명현증가.결론 제삼대후조괄용우복강경담낭절제수술,안전유효,가피면기관삽관화보통후조인기적병발증,치득추엄응용.
Objective To explore the safety of applying LMA ProSealTM (PLMA) to laparoscopic cholecystectomy (LC) by observing the patients' hemodynamic and respiratory indexes. Methods Sixty patients undergoing selective LC were randomly assigned to endotracheal intubation (ETT) group, LMA group or PLMA group. Blood pressure (BP) and heart rate (HR) were recorded before induction of anesthesia and 1 minute after intubation or insertion of the LMA or PLMA. In addition, minute ventilation (MV), tidal volume (TV), peak airway pressure (Ppeak) and PETCO2 were recorded 15 minutes after pressure ventilation and pneumoperitoneum. The cases with the intra operational complications were also recorded. Results BP and HR were significantly increased after intubation than before induction in the ETT group. There were also sig-nificantly different in hemodynamic indexes among the three groups. MV, TV, Ppeak and PETCO2 were significantly different 15 minutes after pressure ventilation and pneumoperitoneum in the each group, but they were no different among the three groups. The patients in the LMA group have serious flatulence and the cases with airway leak were significantly increased in the LMA group than the PLMA group. Conclusion The application of PLMA to LC is safe and effective. It can avoid the intra operational complications which maybe caused by ETT or the LMA and should be spread accordingly.