CAJ | 학술논문

目的:探讨Supreme喉罩在妇科腹腔镜手术中的安全性、有效性、临床效果及并发症.方法:选择135例2010年10月-2012年1月在本院全麻下行妇科腹腔镜手术ASA为Ⅰ~Ⅱ级的患者,随机分为LMA组(68例,采用Supreme喉罩)和ETT组(67例,采用气管插管).观察记录两组的手术时间、麻醉时间、拔管/罩时间及患者苏醒的时间;插管/罩5 min(T1)、腹腔注气前5 min(T2)、腹腔注气后30 min(T3)、腹腔放气后5 min(T4)时脉搏血氧饱和度(SpO2)、呼气末二氧化碳分压(PETCO2)和气道峰压(Ppeak)的变化及通气效果;记录患者拔管/罩后呛咳、体动、反流、误吸、恶心、呕吐及术后咽喉痛等不良反应的发生情况.结果:两组手术和麻醉时间比较,差异无统计学意义(P>0.05);LMA组插管/罩、拔管/罩和苏醒时间均显著短于ETT组,比较差异有统计学意义(P<0.05);两组各时间点的SpO2、PETCO2和Ppeak均在正常范围内,通气效果一致,且两组比较差异均无统计学意义(P>0.05);拔管/罩期间,LMA组呛咳、体动及术后咽喉痛的发生明显少于ETT组,比较差异有统计学意义(P<0.05);两组患者均无反流、误吸.结论:Supreme喉罩通气用于妇科腹腔镜全麻手术对患者循环功能影响小,操作简单,通气效果好,术后并发症少,可完全替代气管插管全麻安全有效地用于妇科腹腔镜手术.
목적:탐토Supreme후조재부과복강경수술중적안전성、유효성、림상효과급병발증.방법:선택135례2010년10월-2012년1월재본원전마하행부과복강경수술ASA위Ⅰ~Ⅱ급적환자,수궤분위LMA조(68례,채용Supreme후조)화ETT조(67례,채용기관삽관).관찰기록량조적수술시간、마취시간、발관/조시간급환자소성적시간;삽관/조5 min(T1)、복강주기전5 min(T2)、복강주기후30 min(T3)、복강방기후5 min(T4)시맥박혈양포화도(SpO2)、호기말이양화탄분압(PETCO2)화기도봉압(Ppeak)적변화급통기효과;기록환자발관/조후창해、체동、반류、오흡、악심、구토급술후인후통등불량반응적발생정황.결과:량조수술화마취시간비교,차이무통계학의의(P>0.05);LMA조삽관/조、발관/조화소성시간균현저단우ETT조,비교차이유통계학의의(P<0.05);량조각시간점적SpO2、PETCO2화Ppeak균재정상범위내,통기효과일치,차량조비교차이균무통계학의의(P>0.05);발관/조기간,LMA조창해、체동급술후인후통적발생명현소우ETT조,비교차이유통계학의의(P<0.05);량조환자균무반류、오흡.결론:Supreme후조통기용우부과복강경전마수술대환자순배공능영향소,조작간단,통기효과호,술후병발증소,가완전체대기관삽관전마안전유효지용우부과복강경수술.
Objective:To explore the safety,efficacy and side effect of laryngeal mask airway supreme(LMA Supreme)in general anesthesia undergoing gynecological laparoscopy surgery. Method:135 ASA gradeⅠ-Ⅱpatients under general anesthesia for elective gynecological laparoscopy surgery were reviewed from Oct. 2010 to Jan. 2012 in the first affiliated hospital of Xiamen University,68 of which were dealt with LMA Supreme(Group LMA)and 67 with endotracheal tube(Group ETT). Operation time,anesthesia time,extubation time,and patient recovery time were observed;SpO2, PETCO2,the peak inspiratory airway pressure(Ppeak)and the effectiveness of ventilation were monitored when LMA Supreme or endotracheal tube placement after 5 min(T1),5 min before intraperitoneal injection gas(T2),30 min after intraperitoneal injection gas(T3),intraperitoneal exhaustion gas after 5 min(T4). Relevant perioperative side effects were recorded. The adverse reactions of anesthesia were recorded included bucking,body movement,countercurrent,aspiration retching,vomiting and postoperative pharyngolaryngeal adverse events in the two groups during extubation. Result:Operation and anesthesia time were not significantly different in the two groups. Intubation,tracheal extubation and recovery times were significantly shorter in group LMA than that in group ETT(P<0.05). SpO2,PETCO2 and Ppeak were normal,and the effectiveness of ventilation were comparable in the two groups at all the time points(P>0.05). The patients bucking,body movement during extubation and postoperative sore throat in group LMA were found significantly lower than those in group ETT(P<0.05),and no countercurrent,aspiration and vomiting in the two groups during extubation. Conclusion:LMA Supreme can provide the same safe and effective ventilation as intubation in gynecological laparoscopy,which can insert easy with fewer the adverse effects,making it can be as a substitute for tracheal intubation and safely and effectively used for gynecological laparoscopy.