CAJ | 학술논문

目的：观察I-gel喉罩用于腔镜甲状腺手术全麻患者通气的效果。方法择期全麻下行腔镜甲状腺手术患者60例，随机分为3组（n=20）：气管插管组、Supreme喉罩组和I-gel喉罩组。记录置入成功率，置入时间，Su?preme喉罩组和I-gel喉罩组记录气道密封压，并行纤维支气管镜检查评分，以评价喉罩对位情况。于置入前(T0)和置入后1 min(T1)、3 min(T2)时，建立CO2操作空间前(T3)，建立CO2操作空间后30 min(T4)，标本切除后10 min(T5)，拔除前(T6)和拔除后1 min(T7)时记录平均动脉压（MAP）、心率（HR）、脉搏血氧饱和度（SpO2），于T1～T5记录呼气末二氧化碳分压p（CO2）和气道峰压（Ppeak）。记录拔除后恶心呕吐、咽喉疼痛等不良反应发生的情况。结果3组置入成功情况差异无统计学意义，与气管插管组比较，I-gel喉罩组和Supreme喉罩组置入的时间缩短（P＜0.05）；气道密封压和纤维支气管镜检查评分Supreme喉罩组和I-gel喉罩组差异无统计学意义。与气管插管组比较，Supreme喉罩组和I-gel喉罩组T1、T6、T7时点MAP、HR降低（P＜0.05），3组各时点SpO2、呼气末p（CO2）和Ppeak比较差异无统计学意义。与Supreme喉罩组和气管插管组比较，I-gel喉罩组咽喉疼痛的发生率降低（P＜0.05）。与Supreme喉罩组比较，I-gel喉罩组罩体带血的发生率降低（P＜0.05）。结论 I-gel喉罩和Supreme喉罩均可安全有效地应用于腔镜甲状腺手术患者的气道管理，且I-gel喉罩的损伤更小，舒适度更佳。
목적：관찰I-gel후조용우강경갑상선수술전마환자통기적효과。방법택기전마하행강경갑상선수술환자60례，수궤분위3조（n=20）：기관삽관조、Supreme후조조화I-gel후조조。기록치입성공솔，치입시간，Su?preme후조조화I-gel후조조기록기도밀봉압，병행섬유지기관경검사평분，이평개후조대위정황。우치입전(T0)화치입후1 min(T1)、3 min(T2)시，건립CO2조작공간전(T3)，건립CO2조작공간후30 min(T4)，표본절제후10 min(T5)，발제전(T6)화발제후1 min(T7)시기록평균동맥압（MAP）、심솔（HR）、맥박혈양포화도（SpO2），우T1～T5기록호기말이양화탄분압p（CO2）화기도봉압（Ppeak）。기록발제후악심구토、인후동통등불량반응발생적정황。결과3조치입성공정황차이무통계학의의，여기관삽관조비교，I-gel후조조화Supreme후조조치입적시간축단（P＜0.05）；기도밀봉압화섬유지기관경검사평분Supreme후조조화I-gel후조조차이무통계학의의。여기관삽관조비교，Supreme후조조화I-gel후조조T1、T6、T7시점MAP、HR강저（P＜0.05），3조각시점SpO2、호기말p（CO2）화Ppeak비교차이무통계학의의。여Supreme후조조화기관삽관조비교，I-gel후조조인후동통적발생솔강저（P＜0.05）。여Supreme후조조비교，I-gel후조조조체대혈적발생솔강저（P＜0.05）。결론 I-gel후조화Supreme후조균가안전유효지응용우강경갑상선수술환자적기도관리，차I-gel후조적손상경소，서괄도경가。
Objective To observe the ventilation effect of I-gel laryngeal mask in endoscopic thyroid surgery under general anesthesia. Methods A total of 60 cases of endoscopic thyroid surgery under general anesthesia, were randomly di?vided into 3 groups (n=20):the group that patients used endotracheal intubation (Group Q);the group that patients employed Supreme laryngeal mask (Group S);the group that patients wore I-gel laryngeal mask (Group I). Success rate of insertion, du?ration of insertion, endotracheal pressure of Group S and Group I worerecored, and fiberoptic bronchoscopy was performed in Group S and I to evaluate the position of laryngeal mask. Mean arterial pressure(MAP), heart rate(HR), pulse oxygen satura?tion (SpO2) at time points of before insertion (T0), 1 min after insertion (T1), 3 min after insertion (T2), before the establishment of CO2 operating space (T3), 30 min after the establishment of CO2 operating space (T4), 10 min after the resection of speci?mens (T5), 1 min before removal of laryngeal mask (T6) and 1 min after the removal of laryngeal mask (T7) were recorded and the end-tidal carbon dioxide pressure [ p(CO2) ]and peak airway pressure (Ppeak) form T1 to T5. were also recorded. Occur?rence of nausea and vomiting, sore throat and other adverse reactions after removal of laryngeal mask were also noted. Re?sults The successful rate of insertion was not significant different among all three groups. Compared with Group Q, inser?tion time was significantly shorter in Group I and S (P<0.05). Endotracheal pressure and fiberoptic bronchoscopy score are not statistically different between Group S and I. Compared with Group Q, MAP and HR in T1, T6 and T7 were significantly lower in Group S and I (P<0.05). SpO2,p(CO2) and Ppeak show no statistical difference between three groups. Compared with Group S and Q, the occurrence of sore throat, painful swallowing and bleeding which is indicated by the appearance of blood in laryngeal were all significantly lower in Group I (P<0.05). Conclusion Both I-gel laryngeal mask and Supreme laryngeal mask can be used safely and effectively in airway management of endoscopic thyroid surgery patients while I-gel laryngeal mask is less hurting and more comfortable than Supreme laryngeal mask.