目的 探讨双管喉罩与气管插管用于全身麻醉妇科腹腔镜手术的安全性和可行性。 方法 2009年1月-5月择期妇科腹腔镜手术患者60例，ASAⅠ～Ⅱ级，随机分为喉罩组（P组）和气管插管组（T组）。记录入室基础值（T0），置罩（管）前（T1），置罩（管）后即刻（T2），置罩（管）后5 min（T3 ），拔除罩（管）即刻（T4），拔除罩（管）后5 min（T5）的收缩压（systolic pressure, SBP），舒张压（diastolic pressure, DBP），心率（heart rate, HR）和脉搏血氧饱和度（pulse oxygen saturation, SpO2），喉罩和气管插管控制呼吸时气腹前后不同时段的气道峰压（airway. maximum pressure, Pmax），潮气量（vital volume, VT）和呼气末二氧化碳分压（end tidal CO2, PETCO2）。记录插罩（管）成功率，及相关并发症。 结果 T2时T组SBP，DBP和HR显著高于P组（P＜0.05），两组术中通气均满意；Pmax，VT和PETCO2组间比较各时点无差异（P＞0.05）。气腹后Pmax和PETCO2组内比较均高于气腹前，差异有统计学意义（P＜0.05）。置罩（管）成功率组间比较差异无统计学意义，拔罩（管）期及术后24 h并发症，喉罩组明显低于气管导管组，差异显著（P＜0.05）。 结论 双管喉罩用于全麻妇科腹腔镜手术通气效果满意，安全可行。
ObjectiveTo investigate the effect of preoperative gum chewing on the postoperative rehabilitation of patients undergoing gynecologic laparoscopic surgery.MethodsA total of 160 patients undergoing elective gynecologic laparoscopic surgery between January and May 2013 were selected to participate in the study. Each patient was randomly assigned to one of the two groups: the trial group (n=80) or the control group (n=80). Thirty to sixty minutes before the surgery, the patients in the trial group chewed one piece of sugarless gum for at least 30 minutes, and then removed the gum before being taken to the operating room; while the patients in the control group chewed nothing. The time to first passage of flatus and the time to first defecation after surgery, length of hospital stay, the degrees of pain at 2-, 4-, 6-, 8-, 24-, 48-hour after surgery, the incidences of postoperative nausea, vomiting, and abdominal distension, postoperative analgesic and antiemetic drug requirement were recorded.ResultsThe mean time to first passage of flatus was significantly earlier in the trial group than that in the control group [(16.49±7.64) vs. (20.25±7.94) hours, P=0.003]. The mean time to first defecation was significantly earlier in the trial group than that in the control group [(48.16±15.25) vs. (55.80±18.97) hours, P=0.006]. The degree of pain at 2-hour after surgery was significantly lighter in the trial group than that in the control group (P<0.05). Fewer participants in the trial group than in the control group experienced postoperative nausea (43.75% vs. 61.25%, P=0.027). There were no significant differences in the length of hospital stay, the degrees of pain at 4-, 6-, 8-, 24- and 48-hour after surgery, incidences of postoperative vomiting and abdominal distension, postoperative analgesic, or antiemetic drug requirement between the two groups (P>0.05).ConclusionsGum chewing before surgery can promote the recovery of gastrointestinal function, reduce postoperative short-term pain, and promote postoperative rehabilitation in patients undergoing gynecologic laparoscopic surgery. Gum chewing before surgery can be used clinically as an easy, inexpensive, safe, and effective procedure.