内镜喉罩对胃内镜黏膜下剥离术气道管理和术后恢复的影响

Effect of endoscopic laryngeal mask on airway management and postoperative recovery in gastric endoscopic submucosal dissection

中文关键词: 内镜黏膜下剥离术  全身麻醉  内镜喉罩  气管导管

英文关键词: Endoscopic submucosal dissection  General anesthesia  Endoscopic laryngeal mask  Endotracheal tube

中文摘要:

      
目的： 评价内镜喉罩用于胃内镜黏膜下剥离术（ESD）患者围术期气道管理和术后恢复的效果。
方法： 选择择期行胃ESD的患者90例，男48例，女42例，年龄18～64岁，BMI 18～25 kg/m²，ASA Ⅰ或Ⅱ级。将患者随机分为两组：内镜喉罩组（E组）和气管插管组（C组），每组45例。麻醉诱导后E组行内镜喉罩通气，消化内镜从喉罩的内镜通道置入；C组则采取气管内插管通气，消化内镜经口置入。记录插管情况（插管成功时间、插管一次性成功例数）、消化内镜置入情况（消化内镜置入时间和退镜例数）、手术时间、拔管时间以及PACU停留时间。记录入室时（T₀）、置入喉罩或气管插管后即刻（T₁）、消化内镜置入时（T₂）、内镜退出时（T₃）、拔除喉罩或气管导管后即刻（T₄）、离开PACU时（T₅）的HR、MAP。记录T₁—T₃时的平均气道压和气道峰压。记录E组改变体位前后、手术结束时的气道密封压和内窥镜显露分级（EVGS）。记录不良反应发生情况以及麻醉科医师和消化内镜医师的满意度。
结果： 与T₀时比较，T₁、T₄时两组HR和MAP明显升高（P＜0.05）。与C组比较，E组置入喉罩成功时间、拔除喉罩时间及PACU停留时间明显缩短，T₁、T₄时HR和MAP明显降低，围拔管期呛咳以及术后咽痛、声嘶发生率明显降低（P＜0.05）。两组插管或置入喉罩一次性成功率、消化内镜置入时间和退镜率差异无统计学意义。E组内镜喉罩的密封性和对位良好。
结论： 内镜喉罩可缩短胃ESD患者的人工气道建立成功时间，对消化内镜操作不造成干扰，缩短拔管时间和PACU停留时间，加快患者术后恢复。

英文摘要:

      
Objective: To evaluate the effect of endoscopic laryngeal mask on perioperative airway management and postoperative recovery in patients undergoing gastric endoscopic submucosal dissection (ESD).
Methods: Ninety patients, aged 18-64 years, BMI 18-25 kg/m², ASA physical status Ⅰ or Ⅱ, who underwent elective gastric ESD were randomly divided into two groups: the endoscopic laryngeal mask group (group E) and the endotracheal tube group (group C), 45 patients in each group. After induction of general anesthesia, group E received endoscopic laryngeal mask airway ventilation, and the endoscope was inserted through the endoscopic channel of the laryngeal mask, group C received tracheal intubation, and the endoscopy was inserted through the mouth. The successful time and one-time success rate of intubation, and the insertion time and withdrawal rate of endoscopy were recorded. The operative time, extubation time and PACU residence time were recorded. HR, MAP were recorded when the patient entered the room (T₀), at the time of intubating (T₁), inserting gastroscopy (T₂), exiting gastroscopy (T₃), extubation (T₄), and leaving PACU (T₅). The average airway pressure and peak airway pressure at T₁-T₃ were recorded. The airway sealing pressure and endoscopic view grading system (EVGS) grading of group E were recorded before and after changing the position, and at the end of surgery. The adverse reactions and the satisfaction of anesthesiologists and gastroenterologists were recorded.
Results: Compared with T₀, HR and MAP were significantly increased at T₁ and T₄ between the two groups (P < 0.05). Compared with group C, the successful time of intubation, the extubation time, and PACU residence time were significantly shortened, HR and MAP were significantly decreased at T₁ and T₄, the incidence of choking cough during extubation, postoperative pharyngeal pain, and hoarseness were significantly decreased (P < 0.05). There were no significant differences in the one-time success rate of intubation, the insertion time and withdrawal rate of endoscopy between the two groups. Endoscopic laryngeal mask showed good sealing and alignment in group E.
Conclusion: Endoscopic laryngeal mask could shorten the success time of establishment of artificial airway in patients with gastric ESD, without interfering with digestive endoscopy operations, shorten extubation time and PACU retention time, maintain intraoperative hemodynamic stability, and reduce adverse reactions.