腹腔镜胆囊切除术中使用喉罩和气管插管对术后早期恢复影响的比较：随机试验
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Comparison of early postoperative recovery between laryngeal mask airway and endotracheal tube in laparoscopic cholecystectomy: A randomized trial
背景与目的
喉罩置入引起的应激反应较气管插管小。本研究旨在评价与气管插管相比，喉罩置入在腹腔镜胆囊切除术中改善术中血流动力学稳定性和减少术后不适的价值。
方 法
将56例在七氟醚麻醉下行腹腔镜胆囊切除术的患者随机分为接受喉罩置入(LMA组)或气管内插管(ETT组)行气道管理。记录气腹前后心率、血压、气道峰压。除术后1小时和术后1天恶心、声音嘶哑、发音困难和喉咙痛外，还记录了术后疼痛和镇痛需求。
结 果
所有患者在两次尝试中均成功地置入喉罩或气管导管。LMA组与ETT组平均最高平均气道压无明显差异(分别为17.7[2.8]mm Hg与19.1[3.8]mm Hg，p=0.159)。与ETT组相比，LMA组高收缩压和心动过缓发生率较高，术后1小时和术后第1天最高疼痛评分较低(3.9[2.0]vs5.4[2.3]，p=.017和5.6[1.9]vs 6.7[1.7]，p=0.042)，而两组镇痛需求相似。术后第1天，LMA组恶心发生率低于ETT组(4/28[14%]vs 12/28[43%]，p=0.031)。
结 论
喉罩是一种有效的通气装置，可减少术中血流动力学应激反应，提高腹腔镜胆囊切除术后早期恢复的质量。
原始文献摘要
Kang SH, Park M. Comparison of early postoperative recovery between laryngeal mask airway and endotracheal tube in laparoscopic cholecystectomy: A randomized trial.[J] .Medicine (Baltimore), 2019, 98: e16022.
Background: Laryngeal mask airway (LMA) insertion provokes fewer stress responses than endotracheal intubation. This study aimed to evaluate the LMA Protector for assessing improvements in intraoperative hemodynamic stability and to reduce postoperative discomfort compared with endotracheal intubation in laparoscopic cholecystectomy.
Methods: Fifty-six patients who underwent laparoscopic cholecystectomy while under sevoflurane-based general anesthesia were randomly allocated to airway management using LMA (LMA group) or endotracheal tube (ETT group). Heart rate, blood pressure, and peak airway pressure were recorded before and after carboperitoneum. Postoperative pain and analgesic requirements were assessed, in addition to nausea, hoarseness, dysphonia, and sore throat during the first 1 hour postoperatively and until postoperative day 1.
Results: All patients underwent successful LMA or ETT placement within 2 attempts. There was no difference in highest mean (SD) peak airway pressure during carboperitoneum between the LMA and ETT groups (17.7 [2.8] mm Hg vs 19.1 [3.8] mm Hg, P=.159, respectively). The incidence of high systolic blood pressure and bradycardia was higher in the LMA group. The highest pain scores 1 hour postoperatively and on postoperative day 1 were lower in the LMA group than in the ETT group (3.9 [2.0] vs 5.4 [2.3], P=.017 and 5.6 [1.9] vs 6.7 [1.7], P=.042, respectively); requirements for analgesics were similar in the 2 groups. The incidence of nausea was lower in the LMA group than in the ETT group until postoperative day 1 (4/28 [14%] vs 12/28 [43%], P=.031, respectively).
Conclusion: The LMA Protector was an effective ventilator device associated with fewer intraoperative hemodynamic stress responses and improved the quality of early recovery after laparoscopic cholecystectomy.
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贵州医科大学高鸿教授课题组
翻译：何幼芹 编辑：何幼芹 审校：王贵龙