CAJ | 학술논문

目的比较Supreme喉罩、ProSeal喉罩与I-gel喉罩用于妇科腹腔镜手术患者气道管理的效果.方法选择2010年1月至2012年9月在卫生部北京医院,拟行择期全身麻醉下妇科腹腔镜手术的患者90例,美国麻醉医师协会(ASA)分级Ⅰ或Ⅱ级,年龄21 ～64岁,体质量45～90 kg,Mallampatti分级Ⅰ～Ⅲ级,经医院伦理委员会审核通过,采用随机数字表法,将患者随机分为3组(n=30):Supreme喉罩组(S组)、ProSeal喉罩组(P组)和I-gel喉罩组(Ⅰ组).根据患者体质量选择喉罩型号,麻醉诱导后置入喉罩,经引流管放置胃管,行机械通气.记录喉罩置入时间、喉罩置入次数、胃管置入次数、喉罩密封压、纤维支气管镜检查评分、术中通气指标、麻醉时间、苏醒时间,记录拔除喉罩后喉罩黏血、返流、咽喉痛、吞咽痛和声音嘶哑的发生情况.结果 3组麻醉时间、苏醒时间、纤支镜检查评分差异无统计学意义(P＞0.05).3组术中SpO2、Ppeak和PETCO2均在正常范围.3组喉罩和胃管的置入成功率均为100％.S组、P组与Ⅰ组喉罩的气道密封压分别为(25±5)、(32±5)、(30 ±6) cm H2O,与S组比较,P组和Ⅰ组喉罩的气道密封压较高(P＜0.05).S组、P组与Ⅰ组喉罩的置入时间分别为(8±4)、(10±5)、(8±3)s,与P组比较,Ⅰ组喉罩置入时间缩短(P＜0.05).S组、P组与Ⅰ组喉罩的咽喉痛发生率分别为17％、20％、3％,与S组、P组比较,Ⅰ组咽喉痛发生率降低(P＜0.05).结论 3组喉罩均可保证有效通气,可安全应用于妇科腹腔镜手术患者的气道管理.ProSeal喉罩、I-gel喉罩较Supreme喉罩气道密封性更好,I-gel喉罩较ProSeal喉罩置入简单,且并发症少.
목적 비교Supreme후조、ProSeal후조여I-gel후조용우부과복강경수술환자기도관리적효과.방법 선택2010년1월지2012년9월재위생부북경의원,의행택기전신마취하부과복강경수술적환자90례,미국마취의사협회(ASA)분급Ⅰ혹Ⅱ급,년령21 ～64세,체질량45～90 kg,Mallampatti분급Ⅰ～Ⅲ급,경의원윤리위원회심핵통과,채용수궤수자표법,장환자수궤분위3조(n=30):Supreme후조조(S조)、ProSeal후조조(P조)화I-gel후조조(Ⅰ조).근거환자체질량선택후조형호,마취유도후치입후조,경인류관방치위관,행궤계통기.기록후조치입시간、후조치입차수、위관치입차수、후조밀봉압、섬유지기관경검사평분、술중통기지표、마취시간、소성시간,기록발제후조후후조점혈、반류、인후통、탄인통화성음시아적발생정황.결과 3조마취시간、소성시간、섬지경검사평분차이무통계학의의(P＞0.05).3조술중SpO2、Ppeak화PETCO2균재정상범위.3조후조화위관적치입성공솔균위100％.S조、P조여Ⅰ조후조적기도밀봉압분별위(25±5)、(32±5)、(30 ±6) cm H2O,여S조비교,P조화Ⅰ조후조적기도밀봉압교고(P＜0.05).S조、P조여Ⅰ조후조적치입시간분별위(8±4)、(10±5)、(8±3)s,여P조비교,Ⅰ조후조치입시간축단(P＜0.05).S조、P조여Ⅰ조후조적인후통발생솔분별위17％、20％、3％,여S조、P조비교,Ⅰ조인후통발생솔강저(P＜0.05).결론 3조후조균가보증유효통기,가안전응용우부과복강경수술환자적기도관리.ProSeal후조、I-gel후조교Supreme후조기도밀봉성경호,I-gel후조교ProSeal후조치입간단,차병발증소.
Objective To compare the efficacy of laryngeal mask airway Supreme,ProSeal and Ⅰ-gel in patients undergoing laparoscopic gynecological surgery.Methods From Jan 2010 to Sep 2012 in Beijing Hospital,approved by hospital ethics committee,ninety ASA Ⅰ or Ⅱ patients,aged 21-64 yr,weighing 45-90 kg,undergoing laparoscopic gynecological surgery,were randomized into 3 groups (n =30 each):LMA Supreme group (group S),LMA ProSeal group (group P)and LMA Ⅰ-gel group (group Ⅰ).Mallampatti test was performed before operation for each case.Anesthesia was induced with target-controlled infusion.LMA Supreme,LMA ProSeal and LMA I-gel were inserted in S,P and I groups respectively.A gastric tube was inserted through the drain tube of the LMA.The LMA placement time,the number of attempts of LMA insertion,the number of attempts of gastric tube placement,the airway sealing pressure,the parameters of ventilation,and complications (sore throat,odynophagia,hoarseness,regurgitation of gastric contents,LMA with adhesion of blood) were recorded.The fiberoptic laryngoscopy scores were assessed after LMA placement.The anesthesia time and recovery time were also recorded.Results There was no significant difference in the anesthesia time,recovery time,fiberoptic bronchoscopy scores among the three groups(P ＞0.05).Parameters of ventilation in each group were normal.The success rates of LMA and gastric tube placement were 100％ in each group.The airway sealing pressure in S,P and I groups were (25 ±5),(32 ±5),(30 ± 6) cm H2O respectively,the airway sealing pressure was significantly higher in group P and group I,compare with group S(P ＜0.05).The LMA placement time in S,P and I groups were (8 ±4),(l0 ±5),(8 ±3) s respectively,while the incidence of sore throat were 17％,20％,3％.The LMA placement time was significantly shorter and the incidence of sore throat was significantly lower in group Ⅰ than in group P (P ＜0.05).Conclusion The three LMA can all be used effectively for gynecological laparoscopic surgery.LMA I-gel and LMA ProSeal can provide higher airway sealing pressure.LMA I-gel provides adequate ventilation during operation with fewer complications.