CAJ | 학술논문

目的：观察第三代喉罩(Proseal laryngeal mask airway ,PLMA)与气管插管在静脉复合全麻下行妇科腹腔镜下全子宫切除术的患者术中心率（HR）、平均动脉压（MAP）、血气分析、呼气末二氧化碳（PETcO2）及术后并发症。方法选择ASA I～Ⅱ级行妇科腹腔镜全子宫切除术手术患者40例，随机分为两组每组20例。P组使用喉罩通气下静脉复合全麻，T组为气管插管通气下静脉复合全麻，监测记录插管/喉罩前后H R、M A P的变化，二氧化碳气腹前后的血气分析的变化，分别于入室后（T0）、气腹前（T1）、气腹30分钟（T2）、气腹60分钟（T3）、气腹后20m i n（T4）抽取桡动脉血行血气分析，并记录同一时刻PETCO2值。比较两组患者在不同时点的PETCO2值与PaCO2值以及术中、术后发生各种并发症的例数。结果 P组置入喉罩前后HR、MAP无明显变化，而T组插管后HR、MAP显著高于插管前(P<0．01)；气腹后PaC02(kPa)明显升高，pH、Pa02(kPa)没有明显变化。气腹后P、T组的PaCO2均显著高于气腹前(P<O.01)。T组并发症的发生显著高于P组(P<O．05)。结论妇科腹腔镜手术中使用第三代喉罩加静脉吸入复合全麻的方法具有安全性好、血流动力学平稳、并发症少的优点，操作简便，易于推广应用。
목적：관찰제삼대후조(Proseal laryngeal mask airway ,PLMA)여기관삽관재정맥복합전마하행부과복강경하전자궁절제술적환자술중심솔（HR）、평균동맥압（MAP）、혈기분석、호기말이양화탄（PETcO2）급술후병발증。방법선택ASA I～Ⅱ급행부과복강경전자궁절제술수술환자40례，수궤분위량조매조20례。P조사용후조통기하정맥복합전마，T조위기관삽관통기하정맥복합전마，감측기록삽관/후조전후H R、M A P적변화，이양화탄기복전후적혈기분석적변화，분별우입실후（T0）、기복전（T1）、기복30분종（T2）、기복60분종（T3）、기복후20m i n（T4）추취뇨동맥혈행혈기분석，병기록동일시각PETCO2치。비교량조환자재불동시점적PETCO2치여PaCO2치이급술중、술후발생각충병발증적례수。결과 P조치입후조전후HR、MAP무명현변화，이T조삽관후HR、MAP현저고우삽관전(P<0．01)；기복후PaC02(kPa)명현승고，pH、Pa02(kPa)몰유명현변화。기복후P、T조적PaCO2균현저고우기복전(P<O.01)。T조병발증적발생현저고우P조(P<O．05)。결론부과복강경수술중사용제삼대후조가정맥흡입복합전마적방법구유안전성호、혈류동역학평은、병발증소적우점，조작간편，역우추엄응용。
Objective:Toinvestigatetheeffectofthe Proseal laryngeal mask airway (PLMA) and endotracheal intubation intravenous anesthesia in gynecological laparoscopic patients,toSearchMean arterial pressure(MAP),heart rate(HR),blood gas analysis, partial pressure of carbon dioxide in end expied gas(PETCO2)and postoperative complications.Methods: 40 patients undergoing gynecological laparoscopic operations, Whose ASAⅠ~Ⅱgrade and ages range from 45 to 60 years old and time from 1.5 to 2 hours, were random ly al ocated to either PLMA group or ETT group(n=20).MAP, HR,PETCO2, blood gas analysis were measured before induction of anesthesia(T0),5min after pneumoperitoneum(T1),at 30min(T2),60min(T3),and 20min (T4)after pneumoperitoneum.The rate of insertion at the first attempt,incidence and degree of airleak,gastric distention and sore theoat were assessed(P<0.05).Results :In group T,HR,MAP afterIntubation were higher that at the same time in group P(P<0.01).After pneumoperitoneum PaC02 (kPa) was significantly increased, pH, Pa02 (kPa) did not change significantly . PacO2 before and after pneumoperitoneum were significantly higher than Veress (P <O.05)in both group.Conclusion: The Proseal laryngeal mask airway induced less reaction and had fewer complications of throat after operation in patients undergoing gynaecological laparoscopy operation.