CAJ | 학술논문

目的评价Ⅰ-gel喉罩用于术前置入鼻胃管的腹腔镜胆囊切除术患者气道管理的效果.方法择期全麻下拟行腹腔镜胆囊切除术患者60例,性别不限,ASA分级Ⅰ-Ⅲ级,年龄26 ～ 64岁,体重54 ～ 90 kg,Mallampati分级Ⅰ-Ⅲ级,采用随机数字表法,将其分为3组(n=20):Ⅰ组经Ⅰ-gel喉罩的引流管放置胃管,Ⅱ组术前经鼻放置胃管并术中保留,麻醉诱导前确定胃管位置,置入I-gel喉罩后不经引流管放置胃管,Ⅲ组术前经鼻放置胃管并术中保留,麻醉诱导前确定胃管位置,置入I-gel喉罩后经引流管放置胃管.术中监测血流动力学指标、SpO2、PETCO2和气道峰压(Ppeak).置入成功后行纤维支气管镜检查评分,并记录胃管位移的发生情况;记录喉罩置入时间、首次置入成功情况、置入刻.度、气道密封压、喉罩漏气和胃管引流情况.拔除喉罩后记录罩体内是否有血液或返流物,通过pH值试纸测定喉罩尖端及罩体的背侧和腹侧的pH值.记录术后24h内口咽部不良反应的发生情况.结果 3组术中血流动力学平稳,SpO2、Ppeak和PEr CO2均在正常范围,Ppeak低于气道密封压.3组喉罩置入时间、首次置入成功率、置入刻度、气道密封压、喉罩漏气发生率、纤维支气管镜检查评分、拔除喉罩时间、术后口咽部不良反应发生率、罩体内带血和有返流物的发生率,术后喉罩尖端及罩体背侧和腹侧的pH值比较差异无统计学意义(P＞0.05),Ⅱ组和Ⅲ组经鼻胃管均未发生位移.Ⅱ组有7例患者经喉罩的引流管有黄色胃液流出,其中仅有2例患者经鼻放置的胃管有引流液.结论对于术前置入鼻胃管的腹腔镜胆囊切除术患者,Ⅰ-gel喉罩易于置入,其气道密封性可靠,通气效果好.
목적 평개Ⅰ-gel후조용우술전치입비위관적복강경담낭절제술환자기도관리적효과.방법 택기전마하의행복강경담낭절제술환자60례,성별불한,ASA분급Ⅰ-Ⅲ급,년령26 ～ 64세,체중54 ～ 90 kg,Mallampati분급Ⅰ-Ⅲ급,채용수궤수자표법,장기분위3조(n=20):Ⅰ조경Ⅰ-gel후조적인류관방치위관,Ⅱ조술전경비방치위관병술중보류,마취유도전학정위관위치,치입I-gel후조후불경인류관방치위관,Ⅲ조술전경비방치위관병술중보류,마취유도전학정위관위치,치입I-gel후조후경인류관방치위관.술중감측혈류동역학지표、SpO2、PETCO2화기도봉압(Ppeak).치입성공후행섬유지기관경검사평분,병기록위관위이적발생정황;기록후조치입시간、수차치입성공정황、치입각.도、기도밀봉압、후조루기화위관인류정황.발제후조후기록조체내시부유혈액혹반류물,통과pH치시지측정후조첨단급조체적배측화복측적pH치.기록술후24h내구인부불량반응적발생정황.결과 3조술중혈류동역학평은,SpO2、Ppeak화PEr CO2균재정상범위,Ppeak저우기도밀봉압.3조후조치입시간、수차치입성공솔、치입각도、기도밀봉압、후조루기발생솔、섬유지기관경검사평분、발제후조시간、술후구인부불량반응발생솔、조체내대혈화유반류물적발생솔,술후후조첨단급조체배측화복측적pH치비교차이무통계학의의(P＞0.05),Ⅱ조화Ⅲ조경비위관균미발생위이.Ⅱ조유7례환자경후조적인류관유황색위액류출,기중부유2례환자경비방치적위관유인류액.결론 대우술전치입비위관적복강경담낭절제술환자,Ⅰ-gel후조역우치입,기기도밀봉성가고,통기효과호.
Objective To evaluate the efficacy of laryngeal mask airway (LMA) Ⅰ-gel for airway management in the patients requiring insertion of nasogastric tube before laparoscopic cholecystectomy.Methods Sixty patients,aged 26-64 yr,weighing 54-90 kg,of ASA physical status Ⅰ-Ⅲ (Mallampati Ⅰ-Ⅲ),scheduled for elective laparoscopic surgery,were randomly divided into Ⅰ,Ⅱ and Ⅲ groups (n =20 each) using a random number table.In group Ⅰ,the nasogastric tube was inserted through the drain tube of LMA I-gel.In group Ⅱ,the nasogastric tube was inserted through the nostril before surgery.In group Ⅲ,the nasogastric tube was inserted through the nostril before surgery,and another nasogastric tube was inserted through the drain tube of LMA I-gel after induction of anesthesia.The hemodynamic parameters,SpO2,PET CO2 and peak airway pressure were monitored during surgery.The fiberoptic laryngoscopy scores were assessed and the development of nasogastric tube displacement was recorded after successful LMA placement.The LMA placement time,success rate of LMA placement at the first attempt,depth of placement,airway sealing pressure,and occurrence of air leakage of LMA and nasogastric tube drainage were recoded.The bloodstains and gastroesophageal reflux were observed after removal of LMA Ⅰ-gel.The pH values were tested at the tip of LMA and on the dorsal and ventral sides of the body of LMA by using pH test papers.The development of adverse reactions in the oropharynx was recorded within 24 h after surgery.Results The hemodynamics was stable and SpO2,peak airway pressure and PETCO2 were all within the normal range during surgery,and Ppeak was lower than airway sealing pressure in the three groups.There were no significant differences between the three groups in LMA placement time,success rate of LMA placement at the first attempt,depth of placement,airway sealing pressure,incidence of air leakage of LMA,fiberoptic laryngoscopy scores,time for removal of LMA I-gel,incidences of adverse reactions in the oropharynx,bloodstains within the body of LMA and gastroesophageal reflux,and pH values at the tip of LMA and on the dorsal and ventral sides of the body of LMA.There was no nasogastric tube displacement in Ⅱ and Ⅲ groups.There were 7 patients developing gastric juice outflow from drainage tube of the LMA I-gel and 2 patients developing gastric juice outflow from the nostril gastrictubes in group Ⅱ.Conclusion For the patients requiring insertion of nasogastric tube before laparoscopic cholecystectomy,insertion of LMA I-gel is easy,and I-gel LMA can assure good airway sealing and adequate ventilation.