ALMA喉罩和Supreme喉罩在腹腔鏡膽囊切除術患者氣道管理中的應用

趙樂 劉樂

摘要：目的 ?比較ALMA喉罩和Supreme喉罩用于腹腔鏡膽囊切除術患者氣道管理的效果。方法 ?選擇2017年2月～4月我院行腹腔鏡膽囊切除術患者80例，采用隨機數字表法分為Supreme喉罩組（S組）和ALMA喉罩組（A組），各40例。兩組麻醉誘導后分別置入4號Supreme喉罩或ALMA喉罩。比較兩組喉罩置入成功情況、置入時間、氣道密封壓、口咽部漏氣、及不良反應的發生情況，并對氣道管理效果和喉罩放置難易程度進行評分。結果 ?A組置入難易評分較S組低，氣道密封壓及氣道管理評分較S組高，口咽部漏氣率較S組低;但A組置入時間較S組延長，鏡片輔助率及引流管漏氣率較S組高，使用笑氣后套囊內壓較S組高，差異均有統計學意義（P<0.05）。兩組胸骨上窩波動率、胃管置入成功率、纖維支氣管鏡檢查分級、罩體帶血、返流發生率、不良反應發生率、喉罩拔除時間、蘇醒時間以及不同時點呼氣末二氧化碳濃度和氣道壓力比較，差異均無統計學意義（P>0.05）。結論 ?ALMA喉罩和Sureme喉罩用于腹腔鏡膽囊切除術患者均可有效通氣，ALMA喉罩較Supreme喉罩氣道密閉性高，穩定性強，術中氣道管理效果好，但置入時間長，部分需喉鏡輔助且囊內壓更易受笑氣影響。

關鍵詞：喉面罩;全身麻醉;膽囊切除術;腹腔鏡

中圖分類號：R164 ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?文獻標識碼：A ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? DOI：10.3969/j.issn.1006-1959.2019.20.021

文章編號：1006-1959（2019）20-0077-05

Application of ALMA Laryngeal Mask and Supreme Laryngeal Mask in Airway Management

of Patients Undergoing Laparoscopic Cholecystectomy

ZHAO Le，LIU Le

Abstract：Objective ?To compare the effects of ALMA laryngeal mask and Supreme laryngeal mask on airway management in patients undergoing laparoscopic cholecystectomy.Methods ?80 patients who underwent laparoscopic cholecystectomy in our hospital from February to April 2017 were randomly divided into Supreme laryngeal mask group （S group） and ALMA laryngeal mask group （group A）， 40 cases each. After the anesthesia was induced in both groups， a Supreme laryngeal mask or an ALMA laryngeal mask was placed. The success of the laryngeal mask placement， the placement time， the airway seal pressure， the oropharyngeal leak， and the occurrence of adverse reactions were compared. The airway management effect and the ease of placement of the mask were scored.Results ?The difficulty of group A was lower than that of group S. The airway sealing pressure and airway management score were higher than that of group S. The airway leakage rate of oropharynx was lower than that of group S. However， the placement time of group A was longer than that of group S. The rate of leakage of the drainage tube was higher than that of the S group. The internal pressure of the cuff was higher than that of the S group after the use of laughing gas，the difference was statistically significant （P<0.05）. The sternal sag of the two groups， the success rate of gastric tube placement， the classification of fiberoptic bronchoscopy， the blood of the hood， the incidence of reflux， the incidence of adverse reactions， the extraction time of the laryngeal mask， the recovery time， and the end of expiration at different time points，there was no significant difference in carbon dioxide concentration and airway pressure （P>0.05）.Conclusion ?ALMA laryngeal mask and Supreme laryngeal mask can be effectively ventilated in patients undergoing laparoscopic cholecystectomy. ALMA laryngeal mask has higher airtightness than Supreme laryngeal mask airway， strong stability， good airway management during operation， but long placement time. Some require laryngoscope assist and the intracapsular pressure is more susceptible to laughter.