摘要：
Objective To observe effects of proseal laryngeal mask airway on coagulative activity of patients who underwent total laparoscopic hysterectomy under general anesthesia.Methods 92 patients who underwent total laparoscopic hysterectomy treated in department of gynaecology of our hospital from January 2013 to October 2015 were selected as the research objects,they were divided by random number table into the control group (n =45) and the observation group (n =47).They all received total intravenous anesthesia,the observation group was given proper proseal laryngeal mask airway,the control group was given ID7.0 tracheal intubation.Heart rate,blood pressure and oxygen saturation before anesthesia (T0),induced intubation or laryngeal mask placed instant moment (T1) in the two groups were recorded,prothrombin time (PT),activated partial thromboplastin time (aPTT),fibrinogen (Fbg) and other coagulative indexes of the two groups preoperative 24 h and postoperative 24 h were tested,whether there was body movement,bucking or not when tube drawing of the two groups were recorded,all patients were followed up for 24 h after the operation to explicit whether there was pharyngalgia,trachyphonia,nausea and vomitting and other complications after the anesthesia.Results There was no significant difference in heart rate and mean arterial pressure at T0 of the two groups,oxygen saturation at T0 and T1 (P ＞ 0.05);heart rate,mean arterial pressure at T1 of the observation group were significantly lower than the control group (P ＜ 0.05).There was no significant difference in PT,aPTT,Fbg of the two groups preoperative 24 h (P ＞ 0.05);PT,aPTT of the observation group postoperative 24 h were significantly longer than the control group,Fbg was significantly lower than the control group(P ＜ 0.05).There was no significant difference in incidence of bloodstain on catheter side wall,trachyphonia,nausea and vomitting and other adverse reactions in the two groups (P ＞ 0.05);incidence of body movement or bucking,pharyngalgia of the observation group were 10.6％,6.4％ respectively,which were significantly lower than the control group (37.8 ％,26.7 ％) (P ＜ 0.05).Conclusion Application of proseal laryngeal mask airway in patients who underwent total laparoscopic hysterectomy under general anesthesia is beneficial to maintaining stable intraoperative heart rate,blood pressure,and can reduce changes of eoagulative activity caused by trauma with less adverse reactions,controlling its indications fully and rational use is beneficial to patients who underwent total laparoscopic hysterectomy under general anesthesia.%目的 观察第三代喉罩对全麻下腹腔镜全子宫切除术患者凝血功能的影响.方法 收集我院2013年1月到2015年10月期间收治的行妇科腹腔镜下行全子宫切除手术患者92例作为研究对象,按随机数字表分为对照组(n=45)与观察组(n=47).均采取全凭静脉麻醉,观察组使用合适型号的第三代喉罩,对照组使用ID7.0气管导管.记录两组麻醉开始前(T0)、诱导插管或喉罩放置即时(T1)时刻的心率、血压与血氧饱和度,分别于术前24 h及术后24 h检测两组凝血酶原时间(PT)、活化部分凝血活酶时间(aPTT)、纤维蛋白原(Fbg)等凝血指标,记录两组拔管时有无体动、呛咳,术后24 h进行随访明确有无咽痛、声嘶、恶心呕吐等麻醉后并发症.结果 两组T0时刻的心率、平均动脉压及T0、T1时刻的血氧饱和度均无统计学意义(P＞0.05);观察组T1时刻的心率、平均动脉压均低于对照组,差异有统计学意义(P＜0.05).两组术前24 h的PT、aPTT、Fbg均无统计学意义(P＞0.05);观察组术后24 h的PT、aPTT长于对照组,Fbg低于对照组,差异均有统计学意义(P＜0.05).两组导管侧壁有血迹、声嘶、恶心呕吐等不良反应发生率的差异无统计学意义(P＞0.05);观察组体动或呛咳、咽痛发生率分别为10.6％、6.4％,低于对照组的37.8％、26.7％,差异均统计学意义(P＜0.05).结论 第三代喉罩在全麻下腹腔镜全子宫切除术患者中的应用利于维持术中心率、血压的稳定,同时减轻由于创伤所致的凝血活性变化,不良反应少.
