ProSeal喉罩与气管插管在老年患者腹腔镜胆囊切除手术中的应用比较

摘要

目的 评价ProSeal喉罩(PLMA)与气管插管对老年患者血流动力学和气道阻力的影响.方法 择期全麻下行腹腔镜胆囊切除术的老年患者80例,年龄65～79岁,采用随机数字表法分为两组(n=40):PLMA组(P组)和气管插管组(T组).记录麻醉诱导前(T0)、置入喉罩/气管导管后1 min(T1)、5 min(T2)、气腹后20 min(T3)、拔除喉罩/气管导管前(T4)、拔除喉罩/气管导管即刻(T5)的收缩压(SBP)、舒张压(DBP)、心率(HR)和血氧饱和度(SpO2),同时在控制潮气量(VT)为8 mL/ kg下监测T1～T3时的平均气道压(Pmean)、气道峰压(Ppeak)和呼气末二氧化碳分压(PETCO2),并观察有无反流误吸等情况及术后咽喉部疼痛等并发症.结果 与T0时比较,T组T1、T4、T5时SBP、DBP升高明显,HR增快明显,且在相应各时点均高于P组(P < 0.05);两组各时点Pmean、Ppeak、PETCO2均在正常范围内,组间比较差异无统计学意义(P > 0.05);术后咽部不适患者T组(11例)明显多于P组(3例)(P < 0.05).结论 PLMA通气用于老年患者腹腔镜胆囊切除术时,患者应激反应小,术后咽喉部并发症少,改善了患者术后的呼吸功能,提高了老年患者围术期安全性.%Objective To evaluate the effects of ProSeal laryngeal mask airway (PLMA) and endotracheal intubation on hemodynamics and airway resistance. Methods Eighty elderly patients aged 65-79 years scheduled for selective laparoscopic cholecystectomy were randomly divided into 2 groups (n = 40, respectively): PLMA group (group P) and endotracheal intubation group (group T). SBP, DBP, HR and SpO2 were recorded at 6 time pionts: before anesthesia induction (T0), 1 min (T1), 5 min (T2) after intubation, 20 min after pneumoperitoneum (T3), befor extubation of PLMA or tracheal (T4), and after extubation (T5), Pmean, Ppeak and PETCO2 were measured at T1-T3 under the tidal volume in 8 mL/kg respectively. And the availability of intraoperative aspiration of reflux and postoperative throat complications were observed. Results In group T, SBP, DBP and HR at T1,T4,T5 were higher than T0 and at the same time points in group P (P < 0.05); the Pmean, Ppeak and PETCO2 were within the normal range during operation in the both groups; the cases of postoperative throat discomfort in group T (11 cases) were more than in group P (3 cases) (P < 0.05). Conclusion ProSeal laryngeal mask airway induces less stress reaction and has fewer complications of throat after operation in the elderly undergoing laparoscopic cholecystectomy; application of PLMA in elderly group can improve respiratory function by reducing the incidents of complications of trachea cannula, and increase the security of elderly patients during general anesthesia.