上海交通大学学报（医学版）

›› 2012, Vol. 32 ›› Issue (3): 375-.doi: 10.3969/j.issn.1674-8115.2012.03.030

• 短篇论著 • 上一篇    

双腔Supreme喉罩用于妇科手术患者的通气效果

施美新, 尤新民   

  1. 上海交通大学医学院附属新华医院崇明分院麻醉科, 上海 202150
  • 出版日期:2012-03-28 发布日期:2012-03-28
  • 通讯作者: 尤新民, 电子信箱: babayouxinmin@hotmail.com。
  • 作者简介:施美新（1965—）, 女, 主治医师；电子信箱: huanhuan1988@163.com。

Efficacy of Supreme laryngeal mask airway on ventilation in patients undergoing gynaecological surgery

SHI Mei-xin, YOU Xin-min   

  1. Department of Anesthesiology, Xinhua Hospital Chongming Branch, Shanghai Jiaotong University School of Medicine, Shanghai 202150, China
  • Online:2012-03-28 Published:2012-03-28

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摘要：

目的 评价双腔Supreme喉罩（SLAM）用于全身麻醉下妇科手术患者的通气效果。方法 80例择期全身麻醉下接受妇科手术的患者分为SLAM运用组(S组) 和气管插管组（T组），每组40例。麻醉诱导后S组置入Supreme喉罩，T组在喉镜直视下插入气管导管。记录两组患者一般情况，置入Supreme喉罩或插入气管导管的时间和情况。记录术中两组各时点心率（HR）、平均动脉压(MAP)、脉搏血氧饱和度（SpO2）、呼气末二氧化碳分压(PETCO2)、气道峰压(Ppeak)的数值。记录Supreme喉罩头中位、屈曲位、过伸位和侧位时的气道密封效果。应用纤支镜插入通气管检查Supreme喉罩对位情况。记录经引流管插入胃管成功次数，拔除喉罩或气管导管后低氧血症、呛咳、恶心呕吐、声嘶、咽喉痛、反流误吸等不良反应的发生情况。记录麻醉时间、拔管时间和苏醒时间。结果 与T组比较，S组置管时间、拔管时间和苏醒时间缩短；拔除喉罩后低氧血症、呛咳、咽喉痛的发生率较低。两组患者均无反流误吸发生。T组插入气管导管后1 min和5 min的HR与MAP明显高于S组（P<0.05）。两组各时点SpO2、PETCO2和Ppeak均在正常范围内, 组间比较差异无统计意义(P>0.05)。S组气道密封压为(25±4) cmH2O，不同头位不影响S组患者气道密封效果。胃管放置成功率100%。纤支镜证实SLAM位置好。结论 SLAM气道密封性可靠，可行正压通气且通气效果好，心血管功能稳定，拔除后不良反应发生少且苏醒快，可安全有效地用于妇科手术患者的全身麻醉气道管理。

关键词: 喉罩, 麻醉, 妇科手术

Abstract:

Objective To evaluate the efficacy of Supreme laryngeal mask airway （SLAM）on ventilation in patients undergoing gynaecological surgery under general anesthesia. Methods Eighty patients undergoing gynaecological surgery under general anesthesia were divided into SLAM group (group S) and tracheal intubation group (group T), with 40 patients in each group. SLAM was inserted after anesthesia induction in group S, and tracheal catheter was intubated under direct laryngoscope after anesthesia induction in group T. The general conditions of patients and the time and conditions of SLAM placement or tracheal catheter intubation were recorded. The heart rates (HR), mean arterial blood pressure (MAP), pulse oxygen saturation(SpO2), end tidal carbon dioxide pressure (PETCO2) and peak airway pressure (Ppeak) were monitored during operation. The airway seal effects at neutral position, flexed position, over-extension position and side position of SLAM were observed. Fiberoptic bronchoscope was inserted into the airway tube of SLMA to verify its position. The times of successful gastric tube placement and incidences of hypoxemia, nausea and vomiting, choking, hoarseness, sore throat and regurgitation of gastric contents after SLAM or tracheal catheter withdrawal were observed. The time of anesthesia, extubation and emergence was recorded. Results The time of intubation, extubation and emergence in group S was shorter than that in group T, and the incidences of hypoxemia, choking and sore throat in group S were lower than those in group T. No regurgitation of gastric contents took place in two groups. HR and MAP 1 min and 5 min after tracheal catheter intubation in group T were significantly higher than those in group S （P<0.05）. SpO2, PETCO2 and Ppeak of different time points in two groups were in the normal range, and there was no significant difference between two groups (P>0.05). The airway seal pressure was (25±4) cmH2O in group S, and different head and neck position did not change the airway sealing effect in group S. The success rate of gastric tube insertion was 100%. Fiberoptic bronchoscopy showed that SLAM was in good position. Conclusion SLAM can provide reliable airway seal effect and adequate ventilation with less complications, which can be effectively applied in gynaecological surgery under general anesthesia with safety.

Key words: laryngeal mask airway, anesthesia, gynaecological surgery