CAJ | 학술논문

目的：探讨LMA supremeTM喉罩和气管插管静脉全麻两种方法用于腹腔镜直肠癌切除手术时对患者血流动力学、呼吸参数变化及术中术后不良反应发生率的影响，评估LMA supremeTM喉罩在腹腔镜直肠癌切除术中应用的安全性及优越性。方法：选择腹腔镜直肠癌切除手术患者40例， ASA Ⅰ～Ⅱ级，随机分成2组，即LMA supreme TM喉罩组（ S组）和气管插管组（ T组），每组20例。麻醉诱导后分别插入LMA supremeTM喉罩和气管插管，记录并比较两组在麻醉诱导前、喉罩和气管导管插入前即刻及插入后即刻、1 min和5 min时收缩压（ SBP）、舒张压（ DBP）、心率（ HR）。记录建立二氧化碳（ CO2）气腹前、后和体位改变后气道平台压（Pplat）、气道峰压（Ppeak）；观察手术过程中返流误吸、术后声嘶、咽痛、呛咳不良反应。结果：与T组比较，S组血流动力学平稳（P＜0．05），呼吸参数稳定变化小（P＜0．05），术中发生返流误吸无统计学差异，术后声嘶、咽痛、呛咳显著减少（P＜0．05）。结论：LMA supremeTM喉罩在腹腔镜直肠癌切除术中应用能达到与气管导管同样的通气效果，对麻醉过程中血流动力学、呼吸参数影响更小，术中术后不良反应显著减少，且操作简单、易学，与气管插管方法相比在临床应用有更好的安全性及优越性。
목적：탐토LMA supremeTM후조화기관삽관정맥전마량충방법용우복강경직장암절제수술시대환자혈류동역학、호흡삼수변화급술중술후불량반응발생솔적영향，평고LMA supremeTM후조재복강경직장암절제술중응용적안전성급우월성。방법：선택복강경직장암절제수술환자40례， ASA Ⅰ～Ⅱ급，수궤분성2조，즉LMA supreme TM후조조（ S조）화기관삽관조（ T조），매조20례。마취유도후분별삽입LMA supremeTM후조화기관삽관，기록병비교량조재마취유도전、후조화기관도관삽입전즉각급삽입후즉각、1 min화5 min시수축압（ SBP）、서장압（ DBP）、심솔（ HR）。기록건립이양화탄（ CO2）기복전、후화체위개변후기도평태압（Pplat）、기도봉압（Ppeak）；관찰수술과정중반류오흡、술후성시、인통、창해불량반응。결과：여T조비교，S조혈류동역학평은（P＜0．05），호흡삼수은정변화소（P＜0．05），술중발생반류오흡무통계학차이，술후성시、인통、창해현저감소（P＜0．05）。결론：LMA supremeTM후조재복강경직장암절제술중응용능체도여기관도관동양적통기효과，대마취과정중혈류동역학、호흡삼수영향경소，술중술후불량반응현저감소，차조작간단、역학，여기관삽관방법상비재림상응용유경호적안전성급우월성。
Objective:To investigate the variations of hemodynamics or respiratory parameters and post -operative complication incidence in laparoscopic rectal cancer surgery to perform the supreme LMA and Tracheal Tubes and to assess the safety or superiority .Methods:Forty ASAⅠ-Ⅱgrade patients underwent rectal cancer surgery were randomly divided into two groups:Supreme LMA group(S), Tracheal Tube group (T).Patients were intubated with supreme LMA , Tracheal Tube respectively after general anesthesia was induced with mid-azolam 0.05 mg/kg, fentanyl 2 μg/kg, etomidate 0.3 mg/kg and vecuronium 0.1 mg/kg.Record and count baseline or variable valus on systonic pressure , dystonic pressure, heart rate, peak inspiration pressure, flat in-spiration pressure as pre-and post-pneumoperitoneum , head down tilt .To observe intra-and post-opera-tion complication on backflow or aspiration , pharyngodynia , trachyphonia , irritating cough.Results:The hemo-dynamic during intubation and respiratory parameters were more stable in group S than in group T (P<0.05). There were no differences on backflow or aspiration during intraoperation between two groups .Postoperation in-cidences were significantly lower in group S than group T on trachyphonia , pharyngalgia or bucking(P<0.05). Conclusions:LMA supreme TM ventilation is effective as well as tracheal tube in rectal cancer surgery .It impacts little variations of hemodynamics or respiratory parameters after general anesthesia and reduces incidence of complications significantly compared with T group .In addition, the method is simple.LMA supremeTMis safer and superior to tracheal tubes on clinical applications .