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| 食管引流型喉罩在妇科腹腔镜手术中的应用 |
| Application of ProSeal laryngeal mask airway in gynecological laparoscopic surgery |
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| DOI：10.12089/jca.2020.05.008 |
| 中文关键词: 食管引流型喉罩 胃内容物 胃进气 超声 胃窦横截面积 |
| 英文关键词: ProSeal laryngeal mask Gastric content Gastric insufflation Ultrasonography Cross-sectional area of the gastric antrum |
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| 中文摘要: |
目的 观察食管引流型喉罩应用于妇科腹腔镜手术的效果,评估其对胃内容物的影响。
方法 选择择期行妇科腹腔镜手术患者60例,年龄28～65岁,BMI 19～29 kg/m2,ASA Ⅰ或Ⅱ级,根据是否经食管引流型喉罩置入引流管均分为置入引流管组(Y组)和未置入引流管组(N组)。全麻诱导待患者睫毛反射消失后行正压面罩通气180 s后置入食管引流型喉罩,Y组经喉罩置入引流管,N组未置入引流管。使用超声监测仪在面罩通气前(T0)、置入喉罩后(T1)和手术结束时(T2)测量并计算胃窦横截面积(CSA),计算T1与T0、T1与T2的CSA差值即ΔCSA1、ΔCSA2。记录两组患者和两组中胃进气患者T1—T2时CSA和ΔCSA1、ΔCSA2。记录腹腔充气前(T1a)、腹腔充气后(T2a)、头低脚高位后(T3a)时SpO2、PETCO2、气道峰压(Ppeak)等呼吸参数和术中是否经引流管引流出胃内容物。记录两组患者和两组中胃进气状态下术后6、12 h恶心呕吐发生情况。
结果 与T0时比较,T1时两组CSA明显增大(P<0.05),T2时N组CSA明显增大(P<0.05)。与T1时比较,T2时Y组CSA明显减小(P<0.05)。Y组ΔCSA2明显大于N组(P<0.05)；N组胃进气患者ΔCSA1明显大于ΔCSA2(P<0.05)。Y组术中有4例引流出胃内液体。Y组胃进气患者术后6 h恶心呕吐发生率明显低于N组(P<0.05)。
结论 食管引流型喉罩用于妇科腹腔镜手术可以提供满意的气道密封效果。与未置入引流管比较,置入引流管可以在术中减轻麻醉诱导导致的胃进气程度、引流残留胃内容物、降低与胃进气相关的术后恶心呕吐发生率。 |
| 英文摘要: |
Objective To observe the effect of ProSeal laryngeal mask in gynecological laparoscopic surgery under general anesthesia and evaluate its effect on gastric contents.
Methods Sixty patients undergoing elective gynecologic laparoscopic surgery were selected, aged 28-65 years, BMI 19-29 kg/m2, falling into ASA physical status Ⅰ or Ⅱ. According to whether the drainage tube was placed into the ProSeal laryngeal mask, these patients were randomly divided into two groups: the drainage tube placement group (group Y) and the drainage tube non-placement group (group N). After induction of general anesthesia, the patient′s eyelash reflex disappeared, and then apositive pressure facemask ventilation was performed for 180 s, and the ProSeal laryngeal mask was placed. Group Y was placed into the drainage tube through the laryngeal mask whereas group N was not placed into the drainage tube. The cross-sectional area (CSA) were measured and calculated before the mask ventilated (T0), after the mask placed (T1) and at the end of the procedure (T2). The difference value of CSA between T1 and T0 (ΔCSA1), T1 and T2 (ΔCSA2) were calculated. The CSA, ΔCSA1 and ΔCSA2 were compared between the two groups and patients with gastric insufflation in the two groups during T0-T2. SpO2, PETCO2 and peak airway pressure (Ppeak) were measured before peritoneal insufflation with CO2 (T1a), after peritoneal insufflation with CO2 (T2a) and after adjusting the body position (T3a), and whether the gastric contents were drained through the drainage tube during the operation. The incidence of nausea and vomiting at 6 and 12 h after surgery was recorded.
Results Compared with T0, the CSA of both groups were obviously increased at T1(P < 0.05), and the CSA of group N was obviously increased at T2(P < 0.05).There was no significant difference in CSA of group Y between T0 and T2. Compared with T1, the CSA of group Y was reduced obviously. There was no significant difference in CSA of group N between T1 and T2. The ΔCSA2 of group Y was increased obviously than that of group N (P < 0.05). There was no significant difference in ΔCSA1 between the two groups. There were no significant difference between ΔCSA1 and ΔCSA2 of patients with gastric insufflation in group Y. The ΔCSA1 of patients with gastric insufflation in group N was increased obviously than ΔCSA2(P < 0.05). Four cases were discharged from the gastric in group Y. The incidence of nausea and vomiting of patients with gastric insufflation in group Y was obviously reduced than that in group N (P < 0.05).
Conclusion ProSeal laryngeal mask in general anesthesia for gynecological laparoscopic surgery can provide satisfactory airway sealing effect. Compared with the non-placed drainage tube, the placement of the drainage tube can reduce gastric insufflation caused by anesthesia during operation, discharge residual gastric contents, and reduce the incidence of postoperative nausea and vomiting associated with gastric insufflation. |
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