一次性免充气喉罩在全麻下腹腔镜阑尾切除手术中的效果观察

Application of disposable inflatable larynx mask in laparoscopic appendectomy under general anesthesia

摘要:

摘要：目的??探讨全麻下腹腔镜阑尾切除手术中使用一次性免充气喉罩的可行性和安全性。方法?选取2017年2月－2017年10月在该院择期行腹腔镜阑尾切除手术的患者60例，美国麻醉医师协会（ASA）评级Ⅰ～Ⅱ级，年龄16～65岁，体重42～75 kg，随机将患者均分为两组：气管插管组（D组）和一次性免充气喉罩组（Z组）。全麻诱导后，D组患者插入气管导管，Z组患者置入一次性免充气喉罩。分别于麻醉诱导前（T1）、管（罩）插入成功时（T2）、管（罩）插入后5 min（T3）、管（罩）拔出前即刻（T4）、拔出后即刻（T5）这5个时间节点记录平均动脉压（MAP）和心率（HR）的变化情况，并观察两组患者气腹前后气道峰压（Ppeak）、呼气末二氧化碳分压（PETCO2）和脉搏血氧饱和度（SpO2）的变化情况。记录患者在麻醉恢复期出现的套囊带血、苏醒躁动和呛咳反应等并发症发生情况，术后48 h记录患者咽喉疼痛和声音嘶哑缓解恢复情况。结果?两组患者在T1时刻MAP和HR差异无统计学意义（P >0.05）；在T2～T5时刻，Z组患者MAP和HR明显低于D组，差异有统计学意义（P <0.05）；两组患者气腹后Ppeak和PETCO2与气腹前比较，差异均有统计学意义（P <0.05），两组患者组间Ppeak和PETCO2比较，差异均无统计学意义（P >0.05）；两组患者气腹前后SpO2差异无统计学意义（P >0.05），组间比较差异也无统计学意义（P >0.05）。套囊带血发生率两组比较，差异无统计学意义（P >0.05）；D组患者在麻醉复苏时出现苏醒躁动、呛咳反应、咽喉疼痛和声音嘶哑等不良反应明显高于Z组（P <0.05）；术后48 h，且对患者的麻醉随访过程中发现，两组患者在缓解咽喉疼痛、声音嘶哑方面比较，差异无统计学意义（P >0.05）。结论?使用一次性免充气喉罩用于全麻下腹腔镜阑尾切除手术中，安全有效的，能够在术中维持呼吸道通畅，并提供有效通气，可明显减轻插管反应，在维持血流动力学稳定、降低呼吸道并发症等方面明显优于气管插管通气。

Abstract:

Abstract: Objective?To observe the feasibility and safety of disposable inflatable larynx mask in laparoscopic appendectomy under general anesthesia.?Methods?60 patients were selected for laparoscopic appendectomy from February to October 2017, with ASA Ⅰ to Ⅱ, age 16 to 65, and weight 42 to 75 kg. All the patients were randomly divided into two groups: tracheal intubation group (D group) and one-time inflatable larynx mask group (Z group). After induction of general anesthesia, D group patients were inserted into the tracheal duct, and Z group patients were placed into a disposable inflatable larynx mask. Before anesthesia induction (T1), when the tube (cover) is successfully inserted (T2), the tube (cover) is inserted after 5 min (T3), immediately before the tube (cover) is pulled out (T4) and immediately after pulling out (T5), these time nodes record changes in MAP and HR. The changes of airway peak pressure (Ppeak), end of exhalation carbon dioxide (PETCO2) and blood oxygen saturation (SpO2) were observed. The complications such as blood clotting, restlessness and cough were recorded during the recovery period of anesthesia, and the pain of throat and hoarseness were relieved after the follow-up of 48 h.?Results?The difference of MAP and HR in tracheal intubation group (D group) and disposable inflatable laryngeal mask group (Z group) was not statistically significant before anesthesia induction (P > 0.05), In group Z, the patients with disposable inflatable larynx mask (Z group) from T2 to T5 were significantly lower in MAP and HR than in patients with tracheal intubation (D group), and the difference was P < 0.05. The difference between Ppeak and PETCO2 in the two groups of patients was statistically significant compared to the pre-abdominal (P < 0.05). The comparative difference between Ppeak and PETCO2 showed P > 0.05, which was not statistically significant. Both the tracheal intubation group (D group) and the one-time inflatable laryngeal mask group (Z group) before and after the abdominal blood oxygen saturation SpO2 showed >0.05, without statistical significance, the difference between groups was also not statistically significant (P > 0.05). The incidence of cystic blood in group Z was similar to that of group D (P > 0.05); Patients in group D had significantly higher adverse reactions such as awakening restlessness, cough response, sore throat, and hoarseness during anesthesia recovery than group Z (P < 0.05); There was no significant difference between the two groups in the treatment of sore throat and hoarse voice (P > 0.05).?Conclusion?It is safe and effective to use a disposable inflatable larynx mask for laparoscopic appendectomy under general anesthesia. The disposable inflatable larynx mask can maintain respiratory tract patency and provide effective ventilation during surgery. It can significantly reduce intubation response. In maintaining hemodynamics stability and reducing respiratory complications, it is superior to tracheal intubation ventilation.