[1]宋先荣,姚朋,张咸虎.ProSeal喉罩对老年患者腹腔镜手术循环和通气功能的影响[J].中国微创外科杂志,2009,09(9):799-805.
　Song Xianrong,Yao Peng,Zhang Xianhu..Effects of ProSeal Laryngeal Mask Airway Ventilation on the Hemodynamics and Respiratory Function in the Elderly Patients Undergoing Laparoscopic Surgery[J].Chinese Journal of Minimally Invasive Surgery,2009,09(9):799-805.
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ProSeal喉罩对老年患者腹腔镜手术循环和通气功能的影响()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
09
期数:
2009年9期
页码:
799-805
栏目:
出版日期:
2009-09-30

文章信息/Info

Title:
Effects of ProSeal Laryngeal Mask Airway Ventilation on the Hemodynamics and Respiratory Function in the Elderly Patients Undergoing Laparoscopic Surgery
作者:
宋先荣; 姚朋; 张咸虎
河南焦作煤业集团中心医院麻醉科，焦作454000
Author(s):
Song Xianrong;  Yao Peng;  Zhang Xianhu.
Department of Anesthesia, Central Hospital of JiaoZuo Mining Group, Jiaozuo 454000, China
关键词:
ProSeal喉罩; 血液动力学; 通气功能; 腹腔镜手术; 老年患者
Keywords:
ProSeal laryngeal mask airway; Hemodynamics; Respiratory function; Laparoscopic cholecystectomy; Elderly patients
分类号:
R614.2
文献标志码:
A
摘要:
目的比较ProSeal喉罩和气管插管对老年患者腹腔镜手术循环和通气功能的影响。方法择期行腹腔镜手术60例，ASAⅠ~Ⅱ级。按手术时间顺序分为2组，喉罩组(LMA组, n=30)和气管插管组(ET组, n=30)。比较2组患者麻醉诱导前(T0)、诱导后(T1)、插入喉罩/气管导管后即刻(T2)及插入喉罩/气管导管后3 min(T3)、拔管前(T4) 、拔管即刻(T5)、拔管后3 min(T6) MAP、HR、SpO2；记录间歇通气5 min(T7) 、15 min(T8) 、30 min(T9) 的分钟通气量（MV）、气道峰压（Ppeak）、潮气量（VT）和PETCO2；同时记录不良反应。结果ET组在T2、T3、T5、T6时点的MAP（109±13），（102±12），（99±11），（96±10）mm Hg显著高于LMA组（83±10），（81±9），（83±9），（81±7）mm Hg (t=-8.683,P=0.000; t=-7668, P=0.000; t=-6.166, P=0.000; t=-6.731; P=0.000)；ET组在T2、T3、T4、T5、T6时点HR（99±11），（95±10），（75±7），（97±11），（91±10）次/min显著高于LMA组（81±7），（79±7），（69±9），（71±7），（74±8）次/min(t=-7.562,P=0.000; t=-7.179, P=0.000; t=-2882, P=0.000; t=-10.922, P=0.000; t=-7.271, P=0.000)； 其他时点2组MAP、HR差异无统计学意义（P＞005）。SpO2均维持在95%~100%。2组T7~T8时点MV、VT、Ppeak差异无统计学意义（P>0.05），LMA组在T9时点Ppeak（19.0±5.0）mm Hg显著高于ET组（13.0±3.0）mm Hg(t=5.636,P=0.000)；LMA组在T9时点P ETCO2（44.7±3.1）mm Hg显著高于ET组(34.1±1.9）mm Hg(t=15.968,P=0.000)。LMA组５例发生不良反应,显著低于ET组13例(χ2=3.774, P=0052)。结论ProSeal喉罩可安全用于腹腔镜手术老年患者，通气可靠，对血液动力学影响轻微，并且不良反应发生率低。
Abstract:
ObjectiveTo compare the effects of laryngeal mask airway (LMA) and endotracheal intubation (ET) on the hemodynamics and respiratory function in elderly patients undergoing laparoscopic cholecystectomy.MethodsSixty patients (ASA class Ⅰ or Ⅱ), scheduled for laparoscopic surgery under general anesthesia were allocated randomly to either LMA group (n=30) or ET group (n=30) with mechanical ventilation. MAP, HR and SpO2 were recorded before anesthesia induction (T0), before intubation (T1), after intubation immediately (T2) and at 3 min (T3), before extubation (T4), and after extubation immediately (T5) and at 3 min (T6). The tidal volume (VT), minute ventilation (MV), peak inspiratory pressure (Ppeak) and PETCO2 were recorded at 10 min (T7), 15 min (T8), and 30 min (T9) of deflation.ResultsIn group ET, MAP at T2, T3, T5, T6 were (109±13), (102±12), (99±11) and (96±10) mm Hg respectively, which were significantly higher than those in group LMA ［(83±10), (81±9), (83±9), and (81±7) mm Hg; t=-8.683, P=0.000; t=-7.668, P=0.000; t=-6.166, P=0000; and t=-6.731, P=0.000, respectively］. The same significant difference was also observed in the HR at T2, T3, T4, T5, T6 ［(99±11), (95±10), (75±7), (97±11), and (91±10) bpm in ET group vs (81±7), (79±7), (69±9), (71±7) and (74±8) bpm; t=-7.562,P=0.000; t=-7.129, P=0.000; t=-2.882, P=0.000; t=-10.922, P=0.000; and t=-7.271, P=0.000, respectively］. No significant differences in MAP and HR were noticed between the two groups at other time points. During the experiment, SpO2 was kept at 95% to 100%. No significant difference was found in VT, MV, Ppeak and PETCO2 between the two groups at T7 and T8 (P>0.05). At T9, the Ppeak and PETCO2 in LMA group were significantly higher than those in ET group ［(190±5.0) mm Hg and (44.7±3.1) mm Hg vs. (13.0±3.0) mm Hg and (34.1±1.9) mm Hg respectively, t=5636, P=0.000 and t=15.968, P=0.000］. In LMA group, 5 patients developed adverse reaction, while in the ET group, 13 patients showed the reaction (χ2=3.774, P=0.052).ConclusionsVentilation with LMA is safe and reliable for elderly patients undergoing laparoscopic surgery with a low rate of adverse reaction. It has slight effect on the hemodynamics of the patients.

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更新日期/Last Update: 2014-01-08