ALMA喉罩和Supreme喉罩在腹腔镜胆囊切除术患者气道管理中的应用

赵乐 刘乐

摘要：目的  比較ALMA喉罩和Supreme喉罩用于腹腔镜胆囊切除术患者气道管理的效果。方法  选择2017年2月～4月我院行腹腔镜胆囊切除术患者80例，采用随机数字表法分为Supreme喉罩组（S组）和ALMA喉罩组（A组），各40例。两组麻醉诱导后分别置入4号Supreme喉罩或ALMA喉罩。比较两组喉罩置入成功情况、置入时间、气道密封压、口咽部漏气、及不良反应的发生情况，并对气道管理效果和喉罩放置难易程度进行评分。结果  A组置入难易评分较S组低，气道密封压及气道管理评分较S组高，口咽部漏气率较S组低;但A组置入时间较S组延长，镜片辅助率及引流管漏气率较S组高，使用笑气后套囊内压较S组高，差异均有统计学意义（P<0.05）。两组胸骨上窝波动率、胃管置入成功率、纤维支气管镜检查分级、罩体带血、返流发生率、不良反应发生率、喉罩拔除时间、苏醒时间以及不同时点呼气末二氧化碳浓度和气道压力比较，差异均无统计学意义（P>0.05）。结论  ALMA喉罩和Sureme喉罩用于腹腔镜胆囊切除术患者均可有效通气，ALMA喉罩较Supreme喉罩气道密闭性高，稳定性强，术中气道管理效果好，但置入时间长，部分需喉镜辅助且囊内压更易受笑气影响。

关键词：喉面罩;全身麻醉;胆囊切除术;腹腔镜

中图分类号：R164                                  文献标识码：A                                   DOI：10.3969/j.issn.1006-1959.2019.20.021

文章编号：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.