目的 比较Supreme喉罩与ProSeal喉罩用于腹腔镜胆囊手术患者气道管理的效果.方法 ASA Ⅰ～Ⅱ级择期腹腔镜胆囊切除手术的患者60例,随机分为Supreme喉罩组(S组)和经ProSeal喉罩组(P组).常规麻醉诱导后,分别插入SLMA或PLMA,并将通气罩充气至60 cmH2O.分别记录喉罩置人成功率、一次放置成功所需时间；记录两组纤支镜下喉罩对位分级情况及两组喉罩密封压.人工气道建立成功时、气腹后5 min及气腹后30 min时的气道峰压(Ppeak)、呼气末二氧化碳分压(PetCO2)、氧合指数( OI =PaO2/FiO2)、SpO2和患者入室时(T1)、置入喉罩即刻(T2)、置入后3min( T3)、拔除喉罩即刻(T4)、拔除后3min( T5)的平均动脉压(MAP)、心率(HR)；并观察术毕喉罩拔除时带血丝及术后咽喉部并发症,如声嘶或咽痛等情况.结果两组患者年龄、性别、身高、体质量、ASA分级、手术时间差异均无统计学意义(P＞0.05).S组的置入时间(13 ±4)s及一次置入成功率(97％)优于P组,气道密闭压( 25±6 cmH2O)低于P组,差异均有统计学意义(P＜0.05),总的置入成功率及纤支镜分级情况,两组比较差异无统计学意义(P＞0.05).两组患者在所选取的各时点的MAP和HR比较,差异无统计学意义(P＞0.05).同时两组患者在人工气道建立成功时、气腹后5 min及气腹后30 min时的Ppeak、PetCO2、OI和SpO2比较,差异均无统计学意义(P＞0.05).两组患者胃管成功置入率均为100％.S组3例拔除喉罩后表面带有血丝,P组5例；两组术后各发生6例轻微咽痛均未见声音嘶哑,差异均无统计学意义(P＞0.05).结论Supreme喉罩和ProSeal喉罩通气效果好,气道密封效果可靠,可安全有效地用于腹腔镜手术,患者的全麻气道管理.两者比较Supreme喉罩置入更加便捷.%Objective To compare the efficacy of laryngeal mask airway supreme and laryngeal mask airway proseal in patients undergoing laparoscopic cholecystectomy. Methods Sixty adult patients ASA I - II scheduled to undergo laparoscopic cholecystectomy under general anesthesia were randomized into group of laryngeal mask airway Supreme (group S, n = 30) and laryngeal mask airway ProSeal (group P, n = 30). The rates of successful placement, placement time, fiberoptic bronchoscope grade, airway sealing pressure were regarded. Ppeak, PetC02, Oland SPO2 were measured by successcful airway placement at respective 5min and 30 min after pneumoperitoneum in the two groups besides recording of MAP and HR before anesthesia (Tl), successful airway placement (T2), 3 min after successful airway placement (T3 ) , laryngeal mask removal (T4) , 3min after laryngeal mask removal (T5), respectively. Side effects were also observed concerning postoperative throat soreness and hoarseness. Results There were no statistical differences in age weight, height, body index, ASA elasstfieation, (P > 0.05). The first insertion sueeess in supreme group (97% ) and proSeal group (80% ) had statistical differences ( P < 0.05). The total insertion success rates were both 100%. The duration of insertion (13±4s) was significantly shorter in the Supreme group than the proSeal group (20±5s) (P<0.05). The oral pharyngeal seal pressure in the supreme group (25 ±6 cmH20) was significantly lower than the Proseal group (31 ±7 cmH2 0). The fibroptic Seore had no statistical difference between the two groups (P>0.05). Ppeak, PetCO2, Oland SPO2 had no significant difference in each time point between the two groups (P > 0.05), and MAP and HR remained no statistical difference ( P > 0.05 ). Conclusion LMA Supreme and LMA proSeal all can provide adequate ventilation during operation which can be used effectively for laparoscopic surgery. The performance efficacy of LMA Supreme is better.
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