SLIPA喉罩与气管插管在老年人腹腔镜结直肠癌根治术中的应用

发布时间：2018-06-22 04:27

本文选题：SLIPA喉罩 + 气管插管　；参考：《浙江大学》2014年硕士论文

【摘要】：目的：通过观察气管插管(TT)与SLIPA喉罩对老年人腹腔镜下行结直肠癌根治术中血流动力学、气道管理的安全性和有效性的影响,探讨老年人腹腔镜结直肠癌根治术的安全气道管理方式。方法：将81例实施腹腔镜下结直癌根治术的老年患者随机分为两组。全麻诱导后分别气管内插管(1组42例),SLIPA喉罩(2组39例),观察喉罩稳定性,记录不同时间点心率、平均动脉压、血氧饱和度、呼末二氧化碳分压、气道吸气峰压、气道顺应性(动态)、气道阻力,监测血气分析变化,并评估反流误吸、通气不足、咽痛等不良事件发生情况。结果： 1.有5例SLIPA喉罩发生移位,3例改为气管插管。 2.在气管插管和喉罩置入的即刻期,气管插管组MAP和HR即刻变化较SLIPA组明显,两组比较有统计学意义的差异(P0.05),但两小时后气腹期、拔除气管导管或喉罩即刻、麻醉苏醒恢复期(拔除喉罩或气管插管送入麻醉复苏室60min-90min)这三个时间点,TT组MAP和HR波动气管插管组较SLIPA组平稳,两者比较有统计学意义的差异(P0.05)。 3.在两小时后气腹期、拔除气管导管或喉罩即刻期,气管插管组呼末二氧化碳分压显著低于SLIPA组(P0.05)。在麻醉苏醒恢复期,气管插管组SP02显著高于SLIPA组(P0.05),血气分析二氧化碳分压显著低于SLIPA组(P0.05)。 4.在两小时后气腹期及术后拔管前,气管插管组气道峰压、气道平台压、气道阻力较SLIPA组显著降低,气道顺应性TT组要好于SLIPA组,两组比较有统计学意义的差异(P0.05)。 5.在麻醉苏醒恢复期,SLIPA组烦躁、返流误吸、呕吐等并发症及带管送监护室的比例较气管插管组显著增加,差异有统计学意义(P0.05)。结论：气管插管在老年人腹腔镜结直肠癌根治术中对血流动力学、呼吸参数,氧和和二氧化碳分压影响小,术后恶心呕吐、误吸及术后躁动、术后需继续呼吸支持等并发症少,较SLIPA喉罩更安全可靠。
[Abstract]:Objective: to observe the effects of tracheal intubation (TT) and SLIPA laryngeal mask on hemodynamics, airway management and safety during laparoscopic radical resection of colorectal cancer in the elderly. To explore the safe airway management of laparoscopic radical resection of colorectal cancer in the elderly. Methods: 81 elderly patients undergoing laparoscopic radical resection of direct nodular carcinoma were randomly divided into two groups. The stability of laryngeal mask was observed, heart rate, mean arterial pressure, saturation of blood oxygen, partial pressure of end-exhalation carbon dioxide, peak inspiratory pressure of airway were recorded at different time points after endotracheal intubation (group 1, 42 cases) and larynx mask (group 2, 39 cases). Airway compliance (dynamic), airway resistance, monitoring of blood gas analysis, and evaluation of adverse events, such as reflux missuction, inadequate ventilation, pharynx, and other adverse events. Results: 1. 5 cases of SLIPA laryngeal mask were displaced and 3 cases were replaced by tracheal intubation. 2. In the immediate phase of tracheal intubation and laryngeal mask implantation, the changes of map and HR in tracheal intubation group were significantly higher than those in SLIPA group (P0.05), but at the pneumoperitoneum stage two hours later, the tracheal tube or larynx mask was removed immediately. Map and HR fluctuating tracheal intubation group in anesthesia recovery stage (removing larynx mask or endotracheal intubation into anaesthesia resuscitation chamber 60min-90min) were more stable than those in SLIPA group (P0.05). In the pneumoperitoneum stage after two hours extubation of tracheal tube or laryngeal mask the partial pressure of end-exhalation carbon dioxide in tracheal intubation group was significantly lower than that in SLIPA group (P0.05). In the recovery period of anesthesia recovery, SP02 in tracheal intubation group was significantly higher than that in SLIPA group (P0.05), and the partial pressure of carbon dioxide in blood gas analysis was significantly lower than that in SLIPA group (P0.05). Two hours after pneumoperitoneum and before extubation, the peak airway pressure, airway plateau pressure and airway resistance in tracheal intubation group were significantly lower than those in SLIPA group, and the airway compliance in TT group was better than that in SLIPA group. There was significant difference between the two groups (P0.05). The proportion of complications such as restlessness, regurgitation, vomiting and the proportion of patients with tracheal intubation in SLIPA group were significantly higher than that in tracheal intubation group (P0.05). Conclusion: endotracheal intubation has little effect on hemodynamics, respiratory parameters, oxygen and carbon dioxide partial pressure, nausea and vomiting, aspiration and restlessness after laparoscopic radical resection of colorectal cancer. Postoperative respiratory support and other complications are less, and more safe and reliable than SLIPA laryngeal mask.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R614;R735.34

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