SLIPA喉罩与气管插管在择期乳腺癌根治术中应用比较

Comparison of novel streamlined pharynx airway liner (SLIPA) and endotracheal intubation in radical mastectomy under general anesthesia

关键词:  SLIPA喉罩  气管插管  全麻

Key words:  SLIPA  endotracheal intubation  general anesthesia

摘要:

［目的］评价SLIPA喉罩与气管插管在择期乳腺癌根治术中应用的有效性和安全性。［方法］随机选取80例乳腺癌患者，分为SLIPA喉罩组和气管插管组，均静脉复合全麻，观察置入成功率、术中漏气率、血流动力学变化、血气变化、术中返流及术后咽痛情况。［结果］两组成功率差异无统计学意义。两组均无反流。两组咽痛发生率相似。术中漏气率SLIPA喉罩组30%，气管插管组0%，血流动力学方面SLIPA喉罩组在插罩前后、拔罩前后MAP、HR无明显波动，而气管插管组在插管前后、拔管前后MAP有明显波动。血气方面SLIPA喉罩组PaCO2在手术60 min时升高，增加潮气量后回落，而气管插管组在手术30 min时降低，减少潮气量后恢复正常。［结论］SLIPA喉罩血流动力学稳定，置入无需喉镜，成功率较高。但是，SLIPA喉罩术中有漏气现象，气道密闭性略差，有CO2蓄积倾向。短时间内不影响通气，但长时间手术建议血气监测。

Abstract:

［Objective］To evaluate the safety and efficacy of the novel streamlined pharynx airway liner (SLIPA) and endotracheal intubation in the radical mastectomy under general anesthesia. ［Methods］Eighty patients scheduled for radical mastectomy were randomized divided into 2 groups, SLIPA group (n=40) and endotracheal intubation group (n=40). The success of handling, incidence of gas leak,rate of regurgitation and sore throat were observed. The MAP, HR before and after handling and taking out were recorded. The pH, PaO2, PaCO2 before and at 30, 60 and 90 min after handling were monitored. ［Results］Both success of insertion and rate of sore throat were similar in two groups without significant difference. No regurgitation was found in two groups. The rate of gas leak in SLIPA group was 30%, significantly higher than that in intubation group (0%). The MAP in SLIPA group was smoother than that in intubation group. PaCO2 increased at 60 min in SLIPA group, went down when tidal volume was changed up.［Conclusion］There is no significant change in blood pressure and heart rate in SLIPA. The quality of laryngeal sealing is not very good. PaCO2 should be monitored in long-time operation.