OPLAC喉罩在腹腔镜子宫切除手术中的临床应用

目的：评估OPLAC喉罩在腹腔镜子宫切除手术麻醉中的应用效果,并探讨其安全性和有效性。方法：随机将全身麻醉下腹腔镜行子宫切除术的子宫肌瘤患者80例,分为两组：OPLAC喉罩组（L组）和气管插管组（T组）。分别记录人工气道建立成功时、成功后30min及手术结束时的平均气道压（Pmean）、气道峰压（Ppeak）、呼气末二氧化碳分压（PetCO2）和患者入室时（T1）、人工气道建立成功时（T2）、建立后10min（T3）、拔管（喉罩）前即刻（T4）、拔管（喉罩）后即刻（T5）的平均动脉压（MAP）、心率（HR）;并观察术中有无反流误吸情况及术后咽喉部并发症,如声嘶或咽痛等。结果：喉罩组和气管插管组在人工气道建立成功时、成功后30min及手术结束时的Pmean、Ppeak、PetCO2比较,差异均无统计学意义。两组在T1时的MAP和HR比较,差异无统计学意义;喉罩组在T2～T5时的MAP、HR明显低于同时点的气管插管组,差异均有统计学意义。两组各时间点SpO2均为100%。喉罩组术中未发现1例反流误吸患者。两组术后各发生3例轻微咽痛,均未见声音嘶哑。结论：全麻OPLAC喉罩通气用于腹腔镜子宫切除术患者优于气管插管,易于维持血流动力学稳定,应激反应轻微,全麻后恢复平稳。

Clinical Application of OPLAC Laryngeal Mask in Hysterectomy under Laparoscopy

Objective：To assess the safety and efficacy of general anesthesia with OPLAC laryngeal mask in hysterectomy under laparoscopy.Methods：Eighty patients（ASAⅠ~Ⅱ）scheduled to undergo hysterectomy under laparoscopy with general anesthesia were randomized into two groups：OPLAC laryngeal mask airway group（group L）and endotracheal intubation group（group T）.Pmean,Ppeak and PETCO2 were measured at intubation or laryngeal mask insertion,30 min after intubation or laryngeal mask insertion,after operation in two groups,respectively.MAP and HR were recorded at before anesthesia（T1）,successful airway placement（T2）,10 min after successful airway placement（T3）,before extubation or laryngeal mask removal（T4）,after extubation or laryngeal mask removal（T5）in two groups,respectively.Reflex,aspiration and side effects with laryngeal mask insertion including throat soreness,hoarseness,etc were carefully monitored during perioperation.Results：Pmean,Ppeak and PETCO2 had no significant difference in two groups at the time of intubation or laryngeal mask insertion was successful,after 30min,and after operation.MAP and HR had no significant difference in two groups at the time of T1.In group T,MAP and HR were significantly higher than group L at the time of T2~T5.No patient showed any signs of reflex,aspiration during operation in group L.Three patients were reported slight throat soreness,but no patients showed hoarseness after operation in two groups,respectively.Conclusion：OPLAC laryngeal mask contributed more stable hemodynamics,less cardiovascular stress and shorter recover time compared to endotracheal intubation technique in patients undergoing hysterectomy with laparoscopy.