Supreme 喉罩与普通型喉罩对侧卧位老年手术患者气道管理和血流动力学的影响

摘要

ABSTRACT:Objective To study the effects of laryngeal mask airway(LMA)Supreme and LMA Classic on airway management and hemodynamic response in elderly patients undergoing surgery in lateral decubitus position.Methods Sixty patients scheduled for elective surgery were divided into two groups,with 30 patients in each group.After anesthesia induction,LMA Supreme and LMA Classic insertion were performed in group S and group C,respectively.Intravenous propofol infusion and sevoflurane inhalation were used to maintain the bispectral index(BIS)between 50 and 60.The catheterization time,success rate of LMA insertion,peak airway pressure(Ppeak), end-tidal carbon dioxide partial pressure(PET CO2 ),oropharyngeal leak pressure(OLP),mean arte-rial blood pressure(MAP),heart rate(HR),and incidence of postoperative adverse events(nause-a,vomiting,sore throat,hoarseness)were recorded in both groups.Results Compared with LMA Classic,LMA Supreme shortened catheterization time((23.29±6.52)s vs (32.81±7.36)s),re-duced intraoperative Ppeak in lateral decubitus position,and increased OLP in both lateral decubi-tus and supine position(P < 0.05).Conclusion LMA Supreme can shorten the catheterization time,improve the success rate of LMA insertion and achieve a high airway sealing pressure. Therefore,LMA Supreme is a safer and more effective airway management device than LMA Classic in elderly patients undergoing surgery in lateral decubitus position.%目的：探讨一次性双管喉罩（Supreme 喉罩）与普通型喉罩对侧卧位老年手术患者气道管理和血流动力学的影响。方法将60例择期手术患者按使用不同的喉罩分为 Supreme 喉罩（S）组和普通型喉罩（C）组，每组30例。2组均行麻醉诱导。麻醉诱导后，S 组置入 Supreme 喉罩，C 组置入普通型喉罩，2组均经静脉泵泵注丙泊酚注射液及吸入七氟醚维持麻醉，维持脑电双频指数值50～60。观察2组置管时间、置入喉罩成功率，术中仰卧位、侧卧位气道峰压（peak airway pressure，Ppeak）、呼气末二氧化碳分压（end-tidal carbon dioxide partial pressure，PET CO2）、口咽部漏气压（oropharyngeal leak pressure，OLP）及置管前、置管后平均动脉压（mean arterial pressure， MAP）、心率（heart rate，HR）和术后不良反应（恶心、呕吐、咽喉部疼痛、声音嘶哑）发生率。结果S 组置管时间为（23．29±6．52）s，较 C 组置管时间[（32．81±7．36）s]明显缩短（P ＜0．05）。与 C 组比较，S 组术中侧卧位 Ppeak 明显降低，仰卧位、侧卧位 OLP 均明显升高（均 P ＜0．05）。结论Supreme 喉罩具有置管时间短、成功率高、密闭性好等优点，是在老年患者侧卧位手术中较普通型喉罩更安全和有效的呼吸道管理工具。