超声辅助下喉罩定位用于腹腔镜手术的对比研究
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摘要
目的观察超声定位喉罩位置在腹腔镜手术中的应用效果。方法选取我院2017年9月1日～2018年8月31日期间腹腔镜胆囊切除手术患者60例,随机分为对照组和试验组各30例。对照组全麻诱导插入喉罩后传统方法定位,试验组全麻诱导插入喉罩后采用超声定位。比较两组患者定位成功后的气道密封压、术中不同时间点的气道峰压(Ppeak)和呼末二氧化碳分压(PetCO_2)以及观察和记录术中胃肠胀气和术后患者咽喉痛等并发症的发生率并比较。结果两组皆能安全地完成手术,试验组的呼吸道密封压明显高于对照组(P<0.05),气腹前(T1)及气腹后(T3)两组呼吸力学参数差异无统计学意义(P>0.05),气腹后10 min(T2),两组患者Ppeak和PetCO_2较气腹前及气腹后明显升高且对照组升高更明显,差异具有统计学意义(P<0.05),试验组在术中胃肠胀气方面发生明显少于对照组(P<0.05)。结论超声应用于喉罩定位成年患者喉罩位置效果较好,有利于提高喉罩通气的质量。
Objective To observe the effect of ultrasonic positioning of laryngeal mask position in laparoscopic surgery.Methods 60 patients with laparoscopic cholecystectomy from September 1, 2017 to August 31, 2017 in Yuyao People's Hospital were selected. They were randomly divided into control group and experimental group. The control group was treated with traditional method positioning after induction of general anesthesia and laryngeal mask insertion. The experimental group was treated with ultrasound positioning after induction of general anesthesia and laryngeal mask insertion. Airway sealing pressure after successful positioning, airway peak pressure(Ppeak) and end-tidal carbon dioxide partial pressure(PetCO_2) at different time points during operation between two groups were compared. The flatulence during operation and postoperative patient's throat pain were observed, recorded and compared. Results Both groups could safely complete the operation. The respiratory sealing pressure of the experimental group was significantly higher than that of the control group(P<0.05). There was no significant difference between the pre-pneumoperitoneum(T1) and the post-pneumoperitoneum(T3) respiratory mechanical parameters(P>0.05). At 10 min(T2) after pneumoperitoneum,Ppeak and PetCO_2 in the two groups were significantly higher than those in the pre-pneumoperitoneum(T1) and the post-pneumoperitoneum(T3). Ppeak and PetCO_2 of the control group increased significantly, and the difference was statistically significant(P<0.05). The flatulence of the operation in the experimental group was significantly less than that of the control group(P<0.05). Conclusion Ultrasound applied in laryngeal mask positioning adult patients has good effect on laryngeal mask position, which is beneficial to improve the quality of laryngeal mask ventilation.
Objective To observe the effect of ultrasonic positioning of laryngeal mask position in laparoscopic surgery.Methods 60 patients with laparoscopic cholecystectomy from September 1, 2017 to August 31, 2017 in Yuyao People's Hospital were selected. They were randomly divided into control group and experimental group. The control group was treated with traditional method positioning after induction of general anesthesia and laryngeal mask insertion. The experimental group was treated with ultrasound positioning after induction of general anesthesia and laryngeal mask insertion. Airway sealing pressure after successful positioning, airway peak pressure(Ppeak) and end-tidal carbon dioxide partial pressure(PetCO_2) at different time points during operation between two groups were compared. The flatulence during operation and postoperative patient's throat pain were observed, recorded and compared. Results Both groups could safely complete the operation. The respiratory sealing pressure of the experimental group was significantly higher than that of the control group(P<0.05). There was no significant difference between the pre-pneumoperitoneum(T1) and the post-pneumoperitoneum(T3) respiratory mechanical parameters(P>0.05). At 10 min(T2) after pneumoperitoneum,Ppeak and PetCO_2 in the two groups were significantly higher than those in the pre-pneumoperitoneum(T1) and the post-pneumoperitoneum(T3). Ppeak and PetCO_2 of the control group increased significantly, and the difference was statistically significant(P<0.05). The flatulence of the operation in the experimental group was significantly less than that of the control group(P<0.05). Conclusion Ultrasound applied in laryngeal mask positioning adult patients has good effect on laryngeal mask position, which is beneficial to improve the quality of laryngeal mask ventilation.
引文
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[15]Lin BC,wu RS,Chen KB,et al.A comparison of the classic and a modified laryngeal mask airway(OPLACTM)in adult patients[J].Anesth Analg,2011,l 12(3):539-544.
[16]Wang JA,Wang CY,Hang YN.Application of ultrasound technique in airway management[J].Int Anesth Resus,2011,32(5):566-569.
[17]Tsui PH,Wan YL,Chen CK.Ultrasound imaging of the larynx and vocal folds:Recent applications and developments[J].Curr Opin Otolaryngol Head Neck Surg,2012,20(6):437-442.
[18]Gupta D,Srirajakalidindi A,Habli N,et al.Ultrasound confirmation of laryngeal mask airway placement correlates with fiberoptielaryngoscope findings[J].Middle East JAnesthesiol,2011,21(2):283-287.
[19]Kang JE,Oh CS,Choi JW,et al.Postoperative pharyngolaryngeal adverse events with laryngeal mask airway(LMASupreme)in laparoscopic surgical procedures with cuff pressure limiting 25cmH2O:Prospective,blind,and randomized study[J].Scientific World Journal,2014,2014:709-801.
[20]Belen JM,NunezM,Anta D,et al.Comparison of Laryngeal mask airw ay supreme and laryngeal mask airway proseal with respect to oropharyngeal leak pressure during laparoscopic cholecystectomy:A randomised controlled tria[J].Euro J Anaesthesiol,2013,30(3):119-123.
[2]Munir N,Hughes D,Sadera G,et al.Ultrasound-guided localisation of trachea for surgical tracheostomy[J].Eur Arch Otorhinolaryngol,2010,267(3):477-479.
[3]Adhikari S,Zeger W,Schmier C,et al.Pilot study to deternline the utility of point-of-care ultrasound in the assessment of difficult laryngoscopy[J].Acad Emerg Med,2011,18(7):754-758.
[4]Chou HC,Tseng WP,Wang CH,et al.Tracheal rapid ultrasound exam(T.R.U.E)for confirming endotracheal tube placement during emergency intubation[J].Resuscitation,2011,82(10):1279-1284.
[5]Hui CM,Tsui BC.Sublingual uItrasound as an assessment method for predicting difficult intubation:A pilot study[J].Anaesthesia,2014,69(4):314-319.
[6]Siddiqui N,Arzola C,Friedman Z,et al.Ultrasound improves cricothyrotomy success in cadavers with poorly defined neck anatomy:A randomized control trial[J].Anesthesiology,2015,123(5):1033-1041.
[7]Pinto J,Cordeiro L,Pereira C,et al.Predicting difficult laryngoscopy using ultrasound measurement of distance from skin to epiglottis[J].J Crit Care,2016,33:26-31.
[8]Stafrace S,Engelhardt T,Teoh WH,et al.Essential ultrasound techniques of the pediatric airway[J].Paediatr Anaesth,2016,26(2):122-131.
[9]Nekhendzy V,Ramaiah VK,Collins J,et al.The safety and efficacy of the use of the flexible laryngeal mask airway with positive pressure ventilation in elective ENTsurgery:A 15-year retrospective single-center study[J].Minerva Anestesiol,2017,83(9):947-955.
[10]周振锋,严敏,郁丽娜,等.超声定位成年患者喉罩位置的效果与纤维支气管镜比较[J].中华麻醉学杂志,2013,33(4):466-469.
[11]Kim J,Kim JY,Kim WO,et al.An ultrasound evaluation of laryngeal mask airway position In pediatric patients:An observational study[J].Anesth Analg,2015,120(2):427-432.
[12]庄心良,曾因明,陈伯銮.现代麻醉学[M].第4版.北京:人民卫生出版社,2014:1029.
[13]Hu LQ,Leavitt OS,Malwitz C,et al.Comparison of laryngeal mask airway insertion methods,including the external larynx lift with pre-inflated cuff,on postoperative pharyngolaryngeal complications:A randomised clinical trial[J].Eur J Anaesthesiol,2017,34(7):448-455.
[14]Chandan SN,Sharma SM,Raveendra US,et al.Fibemptic assessment of laryngeal mask airway placement:A comparison of blind insertion and insertion with the use of a laryngoscope[J].Maxillofae Oral Surg,2009,8(2):95-98.
[15]Lin BC,wu RS,Chen KB,et al.A comparison of the classic and a modified laryngeal mask airway(OPLACTM)in adult patients[J].Anesth Analg,2011,l 12(3):539-544.
[16]Wang JA,Wang CY,Hang YN.Application of ultrasound technique in airway management[J].Int Anesth Resus,2011,32(5):566-569.
[17]Tsui PH,Wan YL,Chen CK.Ultrasound imaging of the larynx and vocal folds:Recent applications and developments[J].Curr Opin Otolaryngol Head Neck Surg,2012,20(6):437-442.
[18]Gupta D,Srirajakalidindi A,Habli N,et al.Ultrasound confirmation of laryngeal mask airway placement correlates with fiberoptielaryngoscope findings[J].Middle East JAnesthesiol,2011,21(2):283-287.
[19]Kang JE,Oh CS,Choi JW,et al.Postoperative pharyngolaryngeal adverse events with laryngeal mask airway(LMASupreme)in laparoscopic surgical procedures with cuff pressure limiting 25cmH2O:Prospective,blind,and randomized study[J].Scientific World Journal,2014,2014:709-801.
[20]Belen JM,NunezM,Anta D,et al.Comparison of Laryngeal mask airw ay supreme and laryngeal mask airway proseal with respect to oropharyngeal leak pressure during laparoscopic cholecystectomy:A randomised controlled tria[J].Euro J Anaesthesiol,2013,30(3):119-123.