欧普乐喉罩在腹腔镜手术中的临床应用研究
摘要
[目的]探讨欧普乐喉罩在腹腔镜精索静脉高位结扎术中应用的可行性和安全性,并观察欧普乐喉罩与经典喉罩比较的优缺点。
[方法]择期腹腔镜精索静脉高位结扎手术患者60例,随机分为气管插管组、经典喉罩组和欧普乐喉罩组,每组20例。观察记录3组患者麻醉前(T1 )、喉罩或气管导管置入前(T2)、置入即刻(T3)、置入后3 min(T4)、气腹前即刻(T5)、气腹后10min(T6)、恢复自主呼吸时(T7)、拔除即刻(T8)、拔除后10min(T9)的心率(HR)、平均动脉压(MAP)、脉搏血氧饱和度(SpO2) ,气腹前后和体位变化前后的气道峰压(Pmax)、气道平均压(Pmex)、呼吸末二氧化碳分压(PETCO2),插入时间、置入次数、术中漏气情况,并记录各组术中和术后的相关并发症:心动过速,高血压,苏醒期躁动,咽喉不适,恶心呕吐,呃逆。
[结果]经典喉罩组和欧普乐喉罩组在置入期、恢复自主呼吸时和拔除期HR、MAP的变化较气管插管组小(P <0.05);3组术中的Pmax、PETCO2均易受手术气腹的影响(P <0.05),但3组比较差异无统计学意义(P>0.05);3组各观察时点的SpO2比较无统计学意义(P >0.05);欧普乐喉罩组插入时间要短于经典喉罩组和气管插管组(P <0.05);经典喉罩组和欧普乐喉罩组患者术中和术后并发症少于气管插管组(P<0.05)。
[结论]欧普乐喉罩与气管插管相比且具有操作简便、应激反应小、并发症少的优点;欧普乐喉罩与经典喉罩相比具有插入简单迅速的优点;欧普乐喉罩可安全、有效的用于腹腔镜精索静脉高位结扎术的麻醉。
Objective To observe the feasibility and the safety of application of Oro-Pharyngeal airway Cap and classic LMA in laparoscopic varicocelectomy,and the characteristics of OPLAC compared to classic LMA.
Methods Sixty ASA I-II patients, scheduled for laparoscopic varicocelectomy were randomly assigned to ET group(n=20)、classic LMA group(n=20)and OPLAC group(n=20). After standard intravenous anesthetic induction, insertion of OPLAC、classic LMA and ET was performed. MAP, HR and SpO2 were recorded before anesthesia induction(T1) ,before intubation(T2) ,after intubation immediately(T3) ,at 3 min after intubation(T4), before CO2 pneumoperitoneum(T5 ),at 10 min after CO2 pneumoperitoneum(T6),the moment of respiratory restoration(T7), after extubation immediately(T8), 10 min after extubation(T9); implantation time、frequency of placement、number of intraoperative leakage and pertinent side-effects(tachycardia, hypertension, restlessness during recovery, throat discomfort, nausea and vomiting, hiccup) were monitored and recorded.
Results In group ET, MAP、HR were significantly higher than those in group classic LMA and group OPLAC at implantation period、the resumption of spontaneous breathing period and removal period(P〈0.05);In there groups ,Pmax、PETCO2 were easily affected by pneumoperitoneum(P〈0.05),but there is no difference between the there groups(P >0.05) ;In all observe periods,there is no SpO2 difference between the two groups(P>0.05); In group OPLAC, the insertion time were shorter than those in group classic LMA and group ET(P〈0.05);In group ET, intraoperative and postoperative complications were significantly higher than those in group classic LMA and group OPLAC(P〈0.05).
Conclusion Compared with ET use in laparoscopic varicocelectomy, OPLAC is simple use、have less stress reaction、have less complications; Compared with classic LMA of insertion, OPLAC is more simple and fast ;OPLAC can be safely and effectively used in laparoscopic varicocelectomy.
[方法]择期腹腔镜精索静脉高位结扎手术患者60例,随机分为气管插管组、经典喉罩组和欧普乐喉罩组,每组20例。观察记录3组患者麻醉前(T1 )、喉罩或气管导管置入前(T2)、置入即刻(T3)、置入后3 min(T4)、气腹前即刻(T5)、气腹后10min(T6)、恢复自主呼吸时(T7)、拔除即刻(T8)、拔除后10min(T9)的心率(HR)、平均动脉压(MAP)、脉搏血氧饱和度(SpO2) ,气腹前后和体位变化前后的气道峰压(Pmax)、气道平均压(Pmex)、呼吸末二氧化碳分压(PETCO2),插入时间、置入次数、术中漏气情况,并记录各组术中和术后的相关并发症:心动过速,高血压,苏醒期躁动,咽喉不适,恶心呕吐,呃逆。
[结果]经典喉罩组和欧普乐喉罩组在置入期、恢复自主呼吸时和拔除期HR、MAP的变化较气管插管组小(P <0.05);3组术中的Pmax、PETCO2均易受手术气腹的影响(P <0.05),但3组比较差异无统计学意义(P>0.05);3组各观察时点的SpO2比较无统计学意义(P >0.05);欧普乐喉罩组插入时间要短于经典喉罩组和气管插管组(P <0.05);经典喉罩组和欧普乐喉罩组患者术中和术后并发症少于气管插管组(P<0.05)。
[结论]欧普乐喉罩与气管插管相比且具有操作简便、应激反应小、并发症少的优点;欧普乐喉罩与经典喉罩相比具有插入简单迅速的优点;欧普乐喉罩可安全、有效的用于腹腔镜精索静脉高位结扎术的麻醉。
Objective To observe the feasibility and the safety of application of Oro-Pharyngeal airway Cap and classic LMA in laparoscopic varicocelectomy,and the characteristics of OPLAC compared to classic LMA.
Methods Sixty ASA I-II patients, scheduled for laparoscopic varicocelectomy were randomly assigned to ET group(n=20)、classic LMA group(n=20)and OPLAC group(n=20). After standard intravenous anesthetic induction, insertion of OPLAC、classic LMA and ET was performed. MAP, HR and SpO2 were recorded before anesthesia induction(T1) ,before intubation(T2) ,after intubation immediately(T3) ,at 3 min after intubation(T4), before CO2 pneumoperitoneum(T5 ),at 10 min after CO2 pneumoperitoneum(T6),the moment of respiratory restoration(T7), after extubation immediately(T8), 10 min after extubation(T9); implantation time、frequency of placement、number of intraoperative leakage and pertinent side-effects(tachycardia, hypertension, restlessness during recovery, throat discomfort, nausea and vomiting, hiccup) were monitored and recorded.
Results In group ET, MAP、HR were significantly higher than those in group classic LMA and group OPLAC at implantation period、the resumption of spontaneous breathing period and removal period(P〈0.05);In there groups ,Pmax、PETCO2 were easily affected by pneumoperitoneum(P〈0.05),but there is no difference between the there groups(P >0.05) ;In all observe periods,there is no SpO2 difference between the two groups(P>0.05); In group OPLAC, the insertion time were shorter than those in group classic LMA and group ET(P〈0.05);In group ET, intraoperative and postoperative complications were significantly higher than those in group classic LMA and group OPLAC(P〈0.05).
Conclusion Compared with ET use in laparoscopic varicocelectomy, OPLAC is simple use、have less stress reaction、have less complications; Compared with classic LMA of insertion, OPLAC is more simple and fast ;OPLAC can be safely and effectively used in laparoscopic varicocelectomy.
引文
1.冯洁化,李朝阳.欧普乐喉罩在全麻中的应用[J].临床麻醉学杂志,2007,23:341—342.
2. Joseph R.Brimacombe.喉罩麻醉原理与实践[M].北京人民卫生出版社,2006:109.
3. Kanaya N,Nakayama M,Kanaya J,Namiki A.Atropine for the treatment of hiccup after larngeal mask airway insertion[J].Anesth Analg 2001;93:791-792.
1. Arthur Sung, MD,Allisoin Kalstein, DO,Palangat Radhakrishnan, MD,Joel Yarmush, MD,and Suhail Raoof,MD. Laryngeal Mask Airway:Use and Clinical Applications. J Bronchol 2007;14:181.
2. Joseph R.Brimacombe.喉罩麻醉原理与实践.北京:人民卫生出版社,2006.35-495.
3. Cook TM. The classic laryngeal mask airway: a tried and tested airway. What now? Br J Anaesth. 2006;96:149-152.
4.冯洁化,李朝阳.欧普乐喉罩在全麻中的应用[J].临床麻醉学杂志,2007,23:341—342.
5. Baskett PJF,Bossaert L,Carli P,et al.Guidelines for the advanced management of the airway and ventilation during redsuscitation.A statement by the Airway and entilation Management of the Working Group of the European Resuscitation Council.Resuscitation 1996;31:187-200.
6. Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.Part 11:neonatal resuscitation. The American Heart Association in collaboration with the International Liaison Committee on Resuscition.Circulation 2000;102:I343-I357.
7. Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.Part 10:pediatric advanced life support. The American Heart Association in collaboration with the Internataional Liaison Committee on Resuscition.Circulation 2000;102:I343-I357.
8. Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.Part 6: advanced cardiovascular life support:section
3:adjuncts for oxygenation,vent and airway control. The American HeartAssociation in collaboration with the International Liaison Committee on Resuscition.Circulation 2000;102:I95-104.
9. Morton T,Brady S,Clancy M. Difficult airway equipment in English emergency departments. Anaesthesia. 2000,55(5):485-488.
10. Graham CA,Brittiliff J,Beard D,Mckeown DW.Airway equipment in Scottish emergency departments.Eur J Emerg Med 2003;10:16-18.
11. Trevisanuto D, Micaglio M, Pitton M et al. Laryngeal mask airway: is the management of neonates requiring positive pressure ventilation at birth changing? Resuscitation 2004; 62:151–157.
12. Martel M,Reardon RF,Cochrane J,Initial experienced emergency physicians using the intubating larngeal mask airway:a case series.Acad Emerg Med 2001;8:815-822.
13. A. J. Goldman and W. H. Rosenblatt.The LMA CTrachTM in airway resuscitation: six case reports.Anaesthesia, 2006, 61:975–977.
14. William H. Rosenblatt, MD. The Use of the LMA-ProSeal? in Airway Resuscitation. Anesth Analg 2003;97:1773–5.
15. Patel P,Verghese C.Delayed extubation facilitated with the use of a laryngeal mask airway(LMA) on the intensive care unit(ICU).Anaesthesia 2000;55:356.
16. Cook TM, Nolan JP. The Pro-seal laryngeal mask airway. Anaesthesia 2002;57:288-289.
17. Hilbert G,Gruson D,Vargas F,et al.Bronchoscopy with bronchoalveolar lavage via the laryngeal mask airway in high-risk hypoxemic immunosuppressed patients.Crit Care Med 2001;29:249-255.
18. Nixon T, Brimacombe J, Goldrick P, McManus S. Airway rescue with the ProSeal Laryngeal Mask Airway in the Intensive Care Unit. Anaesthesia andIntensive Care 2003; 31:475–6.
19. Benumof J. The laryngeal mask airway and the ASA difficult airway algorithm. Anesthesiology 1996;84:686-699.
20. Cook TM. A difficult airway in an obese patient managed with the ProSeal laryngeal mask airway. European Journal of Anaesthesiology 2005; 22: 241–3.
21. Cook TM, Brooks AS, Van der Westerhuizen J, Clarke M.The ProsealTM LMA is a useful rescue device during failed rapid sequence intubation: two additional cases. Canadian Journal of Anaesthesia 2005; 52: 630–3.
22. American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology. 2003;98:1269-1277.
23. Verghese C,Brimacombe J.Survey of laryngeal mask airway usage in 11910 patients:safty and efficacy for conventional and unconventional usage.Anesth Analg 1996;82:129-133.
24. Mello J,Pagedar R,Butani M,Kurkal P,Pandey K.Use of the intubating laryngeal mask airway in a case of ankylosing spondylitis for cronary artery bypass grafting.Eur J Anaesthesiol 2002;19:298-302.
25.胡春林,罗远国.喉罩复合腰硬联合麻醉在肾移植手术中的应用[J].广东医学,2007,28: 678-679.
26.杨小虎.喉罩通气麻醉在泌尿外科腔镜手术中的应用[D].第二军医大学,2007.
27. Maltby JR,Befiault MT,Watson NC,et a1.LMA-Classic and LMAProSeal are efective alternatives to endotracheal intubation for gynecologic laparoscopy.Can J Anaesth,2003,50:71—77.
28.董庆龙,叶靖,庄小雪等.腹腔镜胆道手术患者双管型喉罩通气的可行性[J].中华麻醉学杂志,2005,25:493-496.
29.罗怡君,冯洁华,叶庆明等.欧普乐喉罩在妇科腹腔镜手术中的应用[J].河北医药,2007,29:577-578.
30.杨冯睿,蒋宗滨,黄剑峰等.欧普乐喉罩在腹腔镜精索静脉高位结扎术中的应用[J].广西医学,2009,31:26.
2. Joseph R.Brimacombe.喉罩麻醉原理与实践[M].北京人民卫生出版社,2006:109.
3. Kanaya N,Nakayama M,Kanaya J,Namiki A.Atropine for the treatment of hiccup after larngeal mask airway insertion[J].Anesth Analg 2001;93:791-792.
1. Arthur Sung, MD,Allisoin Kalstein, DO,Palangat Radhakrishnan, MD,Joel Yarmush, MD,and Suhail Raoof,MD. Laryngeal Mask Airway:Use and Clinical Applications. J Bronchol 2007;14:181.
2. Joseph R.Brimacombe.喉罩麻醉原理与实践.北京:人民卫生出版社,2006.35-495.
3. Cook TM. The classic laryngeal mask airway: a tried and tested airway. What now? Br J Anaesth. 2006;96:149-152.
4.冯洁化,李朝阳.欧普乐喉罩在全麻中的应用[J].临床麻醉学杂志,2007,23:341—342.
5. Baskett PJF,Bossaert L,Carli P,et al.Guidelines for the advanced management of the airway and ventilation during redsuscitation.A statement by the Airway and entilation Management of the Working Group of the European Resuscitation Council.Resuscitation 1996;31:187-200.
6. Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.Part 11:neonatal resuscitation. The American Heart Association in collaboration with the International Liaison Committee on Resuscition.Circulation 2000;102:I343-I357.
7. Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.Part 10:pediatric advanced life support. The American Heart Association in collaboration with the Internataional Liaison Committee on Resuscition.Circulation 2000;102:I343-I357.
8. Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.Part 6: advanced cardiovascular life support:section
3:adjuncts for oxygenation,vent and airway control. The American HeartAssociation in collaboration with the International Liaison Committee on Resuscition.Circulation 2000;102:I95-104.
9. Morton T,Brady S,Clancy M. Difficult airway equipment in English emergency departments. Anaesthesia. 2000,55(5):485-488.
10. Graham CA,Brittiliff J,Beard D,Mckeown DW.Airway equipment in Scottish emergency departments.Eur J Emerg Med 2003;10:16-18.
11. Trevisanuto D, Micaglio M, Pitton M et al. Laryngeal mask airway: is the management of neonates requiring positive pressure ventilation at birth changing? Resuscitation 2004; 62:151–157.
12. Martel M,Reardon RF,Cochrane J,Initial experienced emergency physicians using the intubating larngeal mask airway:a case series.Acad Emerg Med 2001;8:815-822.
13. A. J. Goldman and W. H. Rosenblatt.The LMA CTrachTM in airway resuscitation: six case reports.Anaesthesia, 2006, 61:975–977.
14. William H. Rosenblatt, MD. The Use of the LMA-ProSeal? in Airway Resuscitation. Anesth Analg 2003;97:1773–5.
15. Patel P,Verghese C.Delayed extubation facilitated with the use of a laryngeal mask airway(LMA) on the intensive care unit(ICU).Anaesthesia 2000;55:356.
16. Cook TM, Nolan JP. The Pro-seal laryngeal mask airway. Anaesthesia 2002;57:288-289.
17. Hilbert G,Gruson D,Vargas F,et al.Bronchoscopy with bronchoalveolar lavage via the laryngeal mask airway in high-risk hypoxemic immunosuppressed patients.Crit Care Med 2001;29:249-255.
18. Nixon T, Brimacombe J, Goldrick P, McManus S. Airway rescue with the ProSeal Laryngeal Mask Airway in the Intensive Care Unit. Anaesthesia andIntensive Care 2003; 31:475–6.
19. Benumof J. The laryngeal mask airway and the ASA difficult airway algorithm. Anesthesiology 1996;84:686-699.
20. Cook TM. A difficult airway in an obese patient managed with the ProSeal laryngeal mask airway. European Journal of Anaesthesiology 2005; 22: 241–3.
21. Cook TM, Brooks AS, Van der Westerhuizen J, Clarke M.The ProsealTM LMA is a useful rescue device during failed rapid sequence intubation: two additional cases. Canadian Journal of Anaesthesia 2005; 52: 630–3.
22. American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology. 2003;98:1269-1277.
23. Verghese C,Brimacombe J.Survey of laryngeal mask airway usage in 11910 patients:safty and efficacy for conventional and unconventional usage.Anesth Analg 1996;82:129-133.
24. Mello J,Pagedar R,Butani M,Kurkal P,Pandey K.Use of the intubating laryngeal mask airway in a case of ankylosing spondylitis for cronary artery bypass grafting.Eur J Anaesthesiol 2002;19:298-302.
25.胡春林,罗远国.喉罩复合腰硬联合麻醉在肾移植手术中的应用[J].广东医学,2007,28: 678-679.
26.杨小虎.喉罩通气麻醉在泌尿外科腔镜手术中的应用[D].第二军医大学,2007.
27. Maltby JR,Befiault MT,Watson NC,et a1.LMA-Classic and LMAProSeal are efective alternatives to endotracheal intubation for gynecologic laparoscopy.Can J Anaesth,2003,50:71—77.
28.董庆龙,叶靖,庄小雪等.腹腔镜胆道手术患者双管型喉罩通气的可行性[J].中华麻醉学杂志,2005,25:493-496.
29.罗怡君,冯洁华,叶庆明等.欧普乐喉罩在妇科腹腔镜手术中的应用[J].河北医药,2007,29:577-578.
30.杨冯睿,蒋宗滨,黄剑峰等.欧普乐喉罩在腹腔镜精索静脉高位结扎术中的应用[J].广西医学,2009,31:26.