文章摘要

超声评估I-gel喉罩对妇科腹腔镜手术患者胃内进气及术后转归的影响

作者: 1叶 秋萍, 1方 卫萍, 2姚 卫东
1 安徽医科大学第一附属医院麻醉科,合肥 230022
2 皖南医学院弋矶山医院麻醉科,安徽 芜湖 241000
通讯: 方 卫萍 Email: planner@vip.sina.com
DOI: 10.3978/j.issn.2095-6959.2020.02.017
基金: 安徽省重点研究计划与开发项目(201904b11020014)。

摘要

目的:通过超声监测评估在妇科腹腔镜手术中应用I-gel喉罩对患者胃内进气以及术后转归的影响。方法:选取全身麻醉下行妇科腹腔镜手术且手术时间不超过3 h的60例患者,年龄20~65岁,BMI<35 kg/m²,美国麻醉医师协会(American Society of Anesthesiologists,ASA)I~II级。根据手术中使用的通气工具将患者随机分为I-gel喉罩组(I组)和气管导管组(T组)。静脉推注咪达唑仑、舒芬太尼、依托咪酯、顺式阿曲库铵进行麻醉诱导,待意识消失后,容量控制下面罩通气120 s,按照分组分别插入喉罩或气管导管。记录基础值(T0)、插管/喉罩前(T1)、插管/喉罩时(T2)、手术结束(T3)、拔管/喉罩时(T4)的血流动力学参数(血压、心率),使用超声在麻醉诱导前(T5)、诱导后(T6)及手术结束(T7)时采集胃窦部横径、纵径计算其横截面积(cross sectional area,CSA)以及术后患者恶心、呕吐、咽痛、声嘶的发生率。结果:与I组比较,T组在T2和T4时的SBP,DBP和HR均显著增加(P<0.05)。与T0时比较,两组SBP,DBP和HR均显著降低(P<0.05);与T1时比较,T组T2时SBP,DBP和HR明显增加(P<0.05);与T3时比较,T组T4时SBP,DBP和HR明显增加(P<0.05)。T组的胃窦CSA在手术结束时(T7)明显少于I组(P<0.05)。与I组比较,T组术后咽痛、声嘶的发生率明显增加(P<0.01)。结论:I-gel喉罩的应用可能会导致少量气体进入胃内,但未引起返流误吸等严重并发症的发生,可以安全应用于妇科腹腔镜手术患者。
关键词: 超声;胃窦部横截面积;返流;误吸;腹腔镜手术

Evaluation of the effect of I-gel laryngeal mask on gastric insufflation and postoperative outcome in patients undergoing gynecologic laparoscopic surgery via ultrasound

Authors: 1YE Qiuping, 1FANG Weiping, 2YAO Weidong
1 Department of Anesthesiology, First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
2 Department of Anesthesiology, Yijishan Hospital of Wannan Medical College, Wuhu Anhui 241000, China

CorrespondingAuthor:FANG Weiping Email: planner@vip.sina.com

Foundation: This work was supported by the Anhui Key Research Plan and Development Project, China (201904b11020014).

Abstract

Objective: To assess the effects of laryngeal mask and endotracheal intubation on intragastric insufficiency and postoperative outcome in laparoscopic surgery by ultrasonographic measurement. Methods: Sixty American Society of Anesthesiologists (ASA) I or II patients aged 20–65 years, with BMI <35 kg/m2 undergoing gynecologic laparoscopic surgery lasting less than 3 h were randomized into two groups according to the ventilation tools: a laryngeal mask group (group I) and a tracheal tube group (group T). Anesthesia was induced with intravenous injection of midazolam, sufentanil, cisatracurium, and etomidate. After the consciousness disappeared, the volume control was ventilated for 120 s, and the laryngeal mask or tracheal tube was inserted according to the group. The hemodynamic parameters with heart rate and blood pressure were recorded in the moment of before the induction (base values T0), the moment of before catheter immediately (T1), the moment of finishing catheter immediately (T2), the moment of after operating (T3) and the moment of after extubation immediately (T4). The antero-posterior diameter and craniocaudal diameter of the antrum were measured by the ultrasound and the antral cross-sectional area were calculated before induction of anesthesia (T5), after induction (T6), and at the end of surgery (T7). The complications of postoperative nausea and vomiting, sore throat, hoarseness was also recorded postoperatively. Results: Compare with group I, the hemodynamic parameters in group T at T2 and T4 were significantly higher (P<0.05). The hemodynamic parameters in both groups were significantly decreased when compared with those at T0. SBP, DBP and HR were increased significantly at T2 in group T when compared with those at T1 (P<0.05), also increased significantly at T4 when compared with those at T3 (P<0.05). The cross-sectional area of gastric antrum at T7 in group I was significantly smaller than that in group T (P<0.05). Compared with group I, the rate of postoperative sore throat and hoarseness was increased significantly in group T (P<0.05). Conclusion: The application of the I-gel laryngeal mask may result in a small amount of gas into the stomach, but does not cause serious complications such as reflux aspiration, which can be safely applied to gynecological laparoscopic surgery.
Keywords: ultrasound; gastric antral cross-sectional area; reflux; aspiration; laparoscopic surgery