CAJ | 학술논문

目的比较ALMA喉罩和Supreme喉罩用于腹腔镜胆囊切除术患者气道管理的效果.方法本研究为多中心、随机、对照研究.择期行腹腔镜胆囊切除术患者240例,ASA分级Ⅰ级或Ⅱ级,年龄18～64岁,体重50～70 kg,采用随机数字表法,将患者随机分为2组(n=120):Supreme喉罩组(S组)和ALMA喉罩组(A组).两组麻醉诱导后分别置入4号Supreme喉罩或ALMA喉罩,罩囊内注气后通过引流管漏气试验、胸骨上窝按压试验和胃管置入试验检查喉罩是否对位良好,对位良好后行机械通气.喉罩置入成功后行纤维支气管镜检查分级.记录喉罩置入成功情况、置入时间、气道密封压、口咽部漏气、拔除时间、苏醒时间、拔除喉罩时罩体带血和返流及术后咽喉部不良反应的发生情况.对气道管理效果和喉罩放置难易程度进行评分.结果与S组比较,A组喉罩置入时间延长,气道密封压、纤维支气管镜检查分级、气道管理效果评分升高,口咽部漏气发生率降低(P＜0.05),喉罩置入成功率、引流管漏气率、胸骨上窝波动率、胃管置入成功率、喉罩置入难易程度评分、罩体带血、返流发生率、术后咽喉部不良反应发生率、喉罩拔除时间、苏醒时间比较差异无统计学意义(P＞0.05).结论 ALMA喉罩和Sureme喉罩用于腹腔镜胆囊切除术患者均可有效通气,ALMA喉罩气道管理的效果更好.
목적 비교ALMA후조화Supreme후조용우복강경담낭절제술환자기도관리적효과.방법 본연구위다중심、수궤、대조연구.택기행복강경담낭절제술환자240례,ASA분급Ⅰ급혹Ⅱ급,년령18～64세,체중50～70 kg,채용수궤수자표법,장환자수궤분위2조(n=120):Supreme후조조(S조)화ALMA후조조(A조).량조마취유도후분별치입4호Supreme후조혹ALMA후조,조낭내주기후통과인류관루기시험、흉골상와안압시험화위관치입시험검사후조시부대위량호,대위량호후행궤계통기.후조치입성공후행섬유지기관경검사분급.기록후조치입성공정황、치입시간、기도밀봉압、구인부루기、발제시간、소성시간、발제후조시조체대혈화반류급술후인후부불량반응적발생정황.대기도관리효과화후조방치난역정도진행평분.결과 여S조비교,A조후조치입시간연장,기도밀봉압、섬유지기관경검사분급、기도관리효과평분승고,구인부루기발생솔강저(P＜0.05),후조치입성공솔、인류관루기솔、흉골상와파동솔、위관치입성공솔、후조치입난역정도평분、조체대혈、반류발생솔、술후인후부불량반응발생솔、후조발제시간、소성시간비교차이무통계학의의(P＞0.05).결론 ALMA후조화Sureme후조용우복강경담낭절제술환자균가유효통기,ALMA후조기도관리적효과경호.
Objective To compare the efficacy of laryngeal mask airway-Advance (ALMA) and laryngeal mask airway-Supreme (S-LMA) in patients undergoing laparoscopic cholecystectomy.Methods Two hundred and forty ASA Ⅰ or Ⅱ patients,aged 18-64 yr,weighing 50-70 kg,undergoing laparoscopic cholecystectomy,were randomly divided into2 groups (n=120 each):group S-LMA (group S) and group A-LMA (group A).LMA was inserted after induction of general anesthesia with propofol 2.0-2.5 mg/kg,sufentanil 0.2 μg/kg and rocuronium 0.6 mg/kg.After LMA was placed,the rim was immediately inflated and positive pressure was applied to the reservoir bag of anesthesia machine circuit to check for leaks.The plateau pressure at which leaks occurred was recorded.BP,HR,SpO2,PErCO2 and Ppeak were monitored during operation.Fiberoptic bronchoscopy was performed and the placement was scored (0 =unable to see the vocal cords and the ventilation of the lungs was inadequate,4=vocal cords were clearly seen and ventilation was adequate).The rate of successful placement,placement time,the incidence of leaks during operation,duration of anesthesia and surgery,extubation time,emergence time,blood stain on the LMA after being removed,backflow after extubation and postoperatve complacations including sore throat,hoarseness and dysphagia were recorded.The efficacy for airway management and the difficulty of placement were scored.Results There was no significant difference in the rate of successful placement,difficulty of placement scores,blood stain on the LMA after being removed,incidence of backflow,sore throat,hoarseness and dysphogia,anesthesia time,duration of surgery,extubation time and emergence time between the two groups.The placement time was shorter in group S than in group A,but the airway sealing pressure,FOB scores and efficacy for airway management scores were significantly higher and the incidence of leaks during operation was significantly lower in group A than in group S.Conclusion Both A-LMA and S-LMA can provide adequate ventilation during laparoscopic cholecystectomy.The efficacy of A-LMA is better.