影响女性患者喉罩型号精确选择因素的临床研究

发布时间：2018-04-02 22:28

本文选题：女性　切入点：喉罩　出处：《皖南医学院》2017年硕士论文

【摘要】：目的:喉罩(Laryngeal Mask Airway,LMA)作为声门上通气设备,因其操作简单、创伤应激小、心血管反应弱及术后并发症发生率低等优点在临床上广为应用,目前已成为国内、外全身麻醉手术气道管理的常用工具。选择合适的喉罩型号是确保喉罩位置放置准确,对位良好,保证安全有效通气的前提。一直以来,体重都是厂家推荐作为选择喉罩型号的标准。然而,临床实践发现基于患者体重选择喉罩型号有时并不能保证喉罩型号选择的准确性,且该方法也并未体现出临床上的优势。目前,目测患者口腔容积经验性选择喉罩型号是多数麻醉医生常用的方法,但尚缺乏一定的研究依据。因此,本研究拟通过探究患者的体重、身高、张口度、口角距离、下颌角距离和甲颏距离等多种因素与喉罩型号选择间的相关性,旨在找出影响女性喉罩型号精确选择的相关因素,为临床女性喉罩型号的选择提供合理有效的方法,为全身麻醉喉罩通气管理作指导。方法:选取择期全身麻醉手术需喉罩通气的成年女性患者400例,ASA I-II级,年龄18-70岁。排除合并有重要系统器官疾病、有大量返流误吸风险、曾接受过咽喉部手术史、需进行头颈部手术等患者。手术麻醉前测量患者的体重、身高、张口度、口角距离、下颌角距离以及甲颏距离。麻醉诱导后依据经验选择合适型号的喉罩,并置入。记录患者喉罩的置入次数、纤支镜评分和气道密闭压。单因素分析运用独立样本t检验或方差分析,多因素分析采用Logistic回归分析,并联合受试者工作特征曲线(receiver operating characteristic curve,ROC)及曲线下面积(area under the curve,AUC),评估各因素对喉罩型号选择的预测性能。结果:本研究共选择了拟在全身麻醉下行喉罩通气手术的成年女性患者400例,其中,2例患者由于临时直接更改了气管内导管插管行术中气道管理而排除在外。单因素分析发现,体重、张口度、下颌角距离、口角距离和甲颏距离与喉罩型号的选择具有明显的相关性(p0.05),身高与喉罩型号的选择无相关性(p0.05);Logistic回归多因素分析示,口角距离、张口度、下颌角距离、以及甲颏距离与喉罩型号选择相关(p0.05),其OR值分别为33.255、2.869、6.364、1.878,而体重与喉罩型号的选择并无相关性(p0.05)。ROC曲线分析示,体重、体重指数、口角距离、下颌角距离、张口度、甲颏距离和Logistic回归模型新变量Pre-1的曲线下面积(AUC)分别为0.701、0.708、0.766、0.704、0.604、0.611、0.882。结论:体重、口角距离、下颌角距离、张口度、甲颏距离均能影响成年女性Supreme喉罩型号的选择;口角距离用于判断女性Supreme喉罩型号的选择具有较高的可靠性;依据经验综合考虑患者体重、体重指数、口角距离、下颌角距离、张口度和甲颏距离选择喉罩型号较单一体重因素更具有临床优势。
[Abstract]:Objective: laryngeal Mask airway (LMA) is widely used in clinic because of its advantages of simple operation, low trauma stress, weak cardiovascular response and low incidence of postoperative complications.Common tools for airway management in external general anesthesia surgery.Choosing the appropriate laryngeal mask type is the premise to ensure that the laryngeal mask position is accurate, the alignment is good, and the ventilation is safe and effective.Weight has always been recommended by manufacturers as the standard for selecting larynx models.However, clinical practice has found that choosing laryngeal mask model based on patient weight sometimes can not guarantee the accuracy of laryngeal mask selection, and this method does not reflect the clinical advantages.At present, visual measurement of oral volume is often used by most anesthesiologists to select laryngeal mask type empirically, but there is still a lack of research basis.Therefore, this study was designed to explore the correlation between the laryngeal mask type selection and the weight, height, mouth opening, mouth angle distance, mandibular angle distance and thyroid mental distance of the patients.The purpose of this study was to find out the relevant factors affecting the precise choice of laryngeal mask model for women, to provide a reasonable and effective method for the choice of laryngeal mask type in clinical women, and to provide guidance for the ventilation management of laryngeal mask under general anesthesia.Methods: four hundred adult female patients undergoing laryngeal mask ventilation during elective general anesthesia were enrolled in this study, aged 18 to 70 years.The patients who had undergone larynx surgery and had had to undergo head and neck surgery were excluded and complicated with important systemic organ diseases and a large number of regurgitation and aspiration risks.Weight, height, mouth opening, distance between mouth angle, mandible angle and mental distance were measured before anesthesia.After anesthesia induction, the appropriate type of laryngeal mask is selected based on experience and placed.The number of laryngeal mask implantation, fiberoptic bronchoscopy and airway closed pressure were recorded.Single factor analysis was performed by independent sample t-test or variance analysis, multivariate analysis by Logistic regression analysis, and combined with receiver operating characteristic curved-roc and area under curve area under the curveto evaluate the predictive performance of various factors for laryngeal mask model selection.Results: a total of 400 adult female patients undergoing laryngeal mask ventilation under general anesthesia were selected in this study.Univariate analysis showed that body weight, mouth opening, mandibular angle distance, mouth angle distance and nail chin distance were significantly correlated with laryngeal mask type selection. There was no correlation between height and laryngeal mask model selection. Logistic regression analysis showed that the distance between mouth angle and larynx mask was not significant.The degree of mouth opening, the distance between thyroid chin and the area under the curve of Pre-1, a new variable of Logistic regression model, were 0. 701 ~ 0. 708 ~ 0. 766 ~ 0. 704 ~ 0. 604 ~ 0. 604 ~ 0. 611 ~ 0. 882, respectively.Conclusion: weight, distance of mouth angle, distance of mandible angle, distance of mouth opening and distance of thyroid chin can all influence the choice of laryngeal mask of Supreme in adult women, and the distance of mouth angle can be used to judge the choice of laryngeal mask of Supreme in female.According to the experience, it is better to choose the laryngeal mask model than the single weight factor by considering the patient's body weight, body mass index, distance of mouth angle, distance of mandibular angle, opening degree and distance of thyroid chin.
【学位授予单位】：皖南医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614

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