CO2气腹及体位对LMA Supreme喉罩套囊压力的影响

摘要

目的探讨妇科腹腔镜手术中CO2气腹及体位变动对LMA Supreme喉罩套囊内压及气道密闭性影响.方法30例ASAⅠ~Ⅱ级住院需行妇科腹腔镜手术患者，诱导后均插入4号LMA Supreme喉罩.术中监测并记录气腹前(T0)、气腹后屈氏体位前(T1)、屈氏体位后(T2)、解除气腹后5min(T3)的气道峰压(Ppeak)、气道密闭压(Pleak)、套囊内压(ICP)和PETCO2的变化.结果当CO2气腹使气道峰压升高后，套囊内压和气道密闭压较气腹前明显下降，与气腹前比有显著差异性(P<0.05).体位变动后气道峰压进一步升高，套囊内压和气道密闭压进一步下降，与气腹前比有显著差异性，但与屈氏体位前相比差异无显著性.气腹解除后气道峰压回落至气腹前水平，套囊内压和气道密闭压同样回升至气腹前水平，与气腹时有明显差异性(P<0.05).结论 LMA Supreme喉罩在妇科腹腔镜手术中CO2气腹及体位变动导致的气道压增大时其套囊内压是减少的，同时气道密闭压也相应减少，但这一变化尚不至于需要改变套囊充气量.%　　Objective To explore the influence of CO2 aeroperitoneum and body position change on LMA Supreme la-ryngeal mask cuff pressure and airway closeness during laparoscopic surgery. Methods After induction, 30 cases of hospital-ized patients with ASA gradeⅠ~Ⅱto undergo gynecological laparoscopic surgery, at the age of 20~55 years, in the body weight 51~75kg,undertook insertion of LMA Supreme laryngeal mask No 4. During operation were recorded and monitored the peak pressure values of the airway (Ppeak) before aeroperitoneum (T0), before Trendelenburg position after aeroperitoneum (T1), af-ter Trendelenburg position (T2) and 5 minutes after removing aeroperitoneum (T3), the leaking pressure values of the airway (Pleak), intracuff pressure (ICP) and PETCO2. Results When CO2 aeroperitoneum made the airway Ppeak increase, compar-ing with those before aeroperitoneum, ICP and Pleak decreased significantly and had significant difference from those before aeroperitoneum (P<0.05). After changing position, Ppeak increased further, and ICP and Pleak decreased continuously, had significant difference from those before aeroperitoneum, but had no significant difference from those before Trendelenburg posi-tion.After removing aeroperitoneum, Ppeak dropped down to the level before aeroperitoneum, and ICP and Pleak increased to the level before aeroperitoneum, and had significant difference from those during aeroperitoneum (P<0.05). Conclusion During gynecological laparoscopic surgery, LMA Supreme laryngeal mask has decreased intracuff pressure when the airway pres-sure increases due to change in CO2 aeroperitoneum and body position;and meanwhile Pleak decreases correspondingly, but this change does not need to change cuff aeration charge.