天津医药

天津医药 ›› 2015, Vol. 43 ›› Issue (2): 209-213.doi: 10.11958/j.issn.0253-9896.2015.02.026

• 应用研究 • 上一篇    下一篇

I-gel 喉罩用于腔镜甲状腺手术全麻患者的临床观察

李晓婷1,2 ， 王胜斌2 ， 张野1△   

  1. 1 安徽医科大学第二附属医院麻醉科， 合肥 （邮编230022）； 2 安徽医科大学附属安庆医院麻醉科
  • 收稿日期:2014-08-19 修回日期:2014-10-21 出版日期:2015-02-15 发布日期:2015-02-27
  • 通讯作者: 张野 E-mail:1679023571@qq.com
  • 基金资助:
    安徽省科技厅年度重点项目 （1301043030）

Ventilation effect of I-gel laryngeal mask used in endoscopic thyroid surgery under general anesthesia

  • Received:2014-08-19 Revised:2014-10-21 Published:2015-02-15 Online:2015-02-27

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摘要： 摘要： 目的 观察 I-gel 喉罩用于腔镜甲状腺手术全麻患者通气的效果。方法 择期全麻下行腔镜甲状腺手术患者 60 例， 随机分为 3 组 （n=20） :气管插管组、 Supreme 喉罩组和 I-gel 喉罩组。记录置入成功率， 置入时间， Su⁃ preme 喉罩组和 I-gel 喉罩组记录气道密封压， 并行纤维支气管镜检查评分， 以评价喉罩对位情况。于置入前(T0)和置入后 1 min(T1)、 3 min(T2)时， 建立 CO2 操作空间前(T3)， 建立 CO2 操作空间后 30 min(T4)， 标本切除后 10 min(T5)， 拔除前(T6)和拔除后 1 min(T7) 时记录平均动脉压 （MAP）、 心率 （HR）、 脉搏血氧饱和度 （SpO2 ）， 于 T1～T5 记录呼气末二氧化碳分压 p （CO2 ） 和气道峰压 （Ppeak）。记录拔除后恶心呕吐、 咽喉疼痛等不良反应发生的情况。结果 3 组置入成功情况差异无统计学意义， 与气管插管组比较， I-gel 喉罩组和 Supreme 喉罩组置入的时间缩短 （P＜0.05）； 气道密封压和纤维支气管镜检查评分 Supreme 喉罩组和 I-gel 喉罩组差异无统计学意义。与气管插管组比较， Supreme 喉罩组和 I-gel 喉罩组 T1、 T6、 T7 时点 MAP、 HR 降低 （P＜0.05）， 3 组各时点 SpO2、 呼气末 p （CO2 ） 和 Ppeak 比较差异无统计学意义。与 Supreme 喉罩组和气管插管组比较， I-gel 喉罩组咽喉疼痛的发生率降低 （P＜0.05）。与 Supreme 喉罩组比较， I-gel 喉罩组罩体带血的发生率降低 （P＜0.05）。结论 I-gel 喉罩和 Supreme 喉罩均可安全有效地应用于腔镜甲状腺手术患者的气道管理， 且I-gel 喉罩的损伤更小， 舒适度更佳。

关键词: 麻醉, 全身； 喉面罩； 腔镜； 甲状腺切除术

Abstract: Abstract： Objective To observe the ventilation effect of I-gel laryngeal mask in endoscopic thyroid surgery under general anesthesia. Methods A total of 60 cases of endoscopic thyroid surgery under general anesthesia, were randomly di⁃ vided into 3 groups (n= 20): the group that patients used endotracheal intubation (Group Q); the group that patients employed Supreme laryngeal mask (Group S) ; the group that patients wore I-gel laryngeal mask (Group I). Success rate of insertion, du⁃ ration of insertion, endotracheal pressure of Group S and Group I worerecored, and fiberoptic bronchoscopy was performed in Group S and I to evaluate the position of laryngeal mask. Mean arterial pressure(MAP), heart rate(HR), pulse oxygen satura⁃ tion (SpO2) at time points of before insertion (T0), 1 min after insertion (T1), 3 min after insertion (T2), before the establishment of CO2 operating space (T3), 30 min after the establishment of CO2 operating space (T4), 10 min after the resection of speci⁃ mens (T5), 1 min before removal of laryngeal mask (T6) and 1 min after the removal of laryngeal mask (T7) were recorded and the end-tidal carbon dioxide pressure [ p(CO2) ]and peak airway pressure (Ppeak) form T1 to T5. were also recorded. Occur⁃ rence of nausea and vomiting, sore throat and other adverse reactions after removal of laryngeal mask were also noted. Re⁃ sults The successful rate of insertion was not significant different among all three groups. Compared with Group Q, inser⁃ tion time was significantly shorter in Group I and S (P＜0.05). Endotracheal pressure and fiberoptic bronchoscopy score are not statistically different between Group S and I. Compared with Group Q, MAP and HR in T1, T6 and T7 were significantly lower in Group S and I (P＜0.05). SpO ， p(CO ) and Ppeak show no statistical difference between three groups. Compared with Group S and Q, the occurrence of sore throat, painful swallowing and bleeding which is indicated by the appearance of blood in laryngeal were all significantly lower in Group I (P <0.05). Conclusion Both I-gel laryngeal mask and Supreme laryngeal mask can be used safely and effectively in airway management of endoscopic thyroid surgery patients while I-gel laryngeal mask is less hurting and more comfortable than Supreme laryngeal mask.

Key words: anesthesia, general, laryngeal masks, laparoscopes, thyroidectomy