预给氧快速顺序诱导食管引流型喉罩全麻对腹腔镜胆囊切除术胃胀气的影响
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摘要：目的 观察预给氧快速顺序诱导食管引流型喉罩通气全麻对腹腔镜胆囊切除术中胃胀气的影响，及术后恶心呕吐发生率。方法 实施手术的60例腹腔镜胆囊切除术患者ASAⅠ～Ⅱ，采用随机数字表法分为预给氧快速顺序诱导食管引流型喉罩组A组（30例）和正压给氧常规快诱导食管引流型喉罩组B组（30例）。观察气腹后胃胀气发生率及程度，记录胃胀气评分，影响手术操作置入胃管减压例数，随访术后恶心呕吐病例数。结果 A组无1例胃胀气（0%），视觉评分（3.86±1.48），B组胃胀气10 例（33.3%），视觉评分（6.36±1.17），两组比较差异有统计学意义（P
关键词：预给氧；快速顺序诱导；食管引流型喉罩；胃胀气；腹腔镜胆囊
Effects of Advancing to Oxygen Rapid Sequence Induction of General Anesthesia with Proseal Laryngeal Mask Airway on Gastric Insufflation in Laparoscopic Cholecystectomy
CHANG Xu-fei，ZHANG Bao-lu
（Department of Anesthesiology， Yanqing District Hospital ，Peking University Third Hospital Yanqing Hospital， Beijing 102100，China）
Abstract：Objective To observe effectiveness of advancing to oxygen rapid sequence induction of general anesthesia with proseal laryngeal mask airway（PLMA） on gastric insufflation in laparoscopic cholecystectomy surgery， the rates of nausea and vomiting after surgery.Methods Sixty ASAⅠ～Ⅱpatients forundergoing laparoscopic cholecystectomy surgery，who were randomly divided into two groups，30 cases in each group.Group A were advanced to oxygen with no positive pressure ventilation before rapid sequence induction of anesthesia.Group B were given oxygen with positive pressure ventilation after rapid induction of anesthesia.Investigated and recorded the cases and dgree of flatulence after pneumoperitoneum ，the cases of gastric tube through PLMA ，the cases of nausea and vomting after surgery. Results There were no cases （0%）of gastric insufflation in group A，VAS（3.86±1.48），and 10 cases（33.3%） in group B，VAS（6.36±1.17），there was a significant difference between A and B（P
Key words：Advance to oxygen；Rapid sequence induction；Proseal laryngeal mask airway；Gastric insufflation；Laparoscopic cholecystectomy
喉罩通气全麻用于腹腔镜胆囊手术，操作简单，且通气可靠，在放罩和拔罩时对血流动力学影响小[1]。然而腹腔镜胆囊切除手术操作空间相对狭小，如果在麻醉诱导过程中不能处理好给氧方式，会发生胃胀气，影响手术视野，甚至还会增加反流误吸等并发症的发生率[2]。快速顺序诱导（rapid sequence induction RSI）主要是充分的预氧合，快速按顺序注射诱导药，避免正压通气[3]，以减少胃内进气率，减少术中胃胀气、反流和误吸的发生率。本文采用预给氧快速顺序诱导，食管引流型喉罩通气全麻观察其对胃胀气的影响。