可弯曲喉罩与加强型气管导管用于俯卧位腰椎手术的比较

发布时间：2018-05-12 21:10

本文选题：气道管理 + 插管法　；参考：《北京大学学报(医学版)》2017年02期

【摘要】：目的:评价可弯曲喉罩(flexible laryngeal mask airway,FLMA)用于俯卧位腰椎手术的安全性和可行性。方法:择期腰椎手术患者120例,随机均分为FLMA组和钢丝加强气管导管(reinforced tracheal tube,RTT)组,全身麻醉诱导后分别置入FLMA或RTT,记录诱导开始时(T0)、人工气道置入时(T1)、置入后1 min(T2)及拔出时(T3)、拔出后1 min(T4)的心率(heart rate,HR)、收缩压(systolic blood pressure,SBP)和舒张压(diastolic blood pressure,DBP)。记录置入时间、置入次数以及平卧位和俯卧位后气道峰压、喉罩气道密封压和纤维支气管镜检查分级,记录手术开始时、手术开始后1 h、手术开始后2 h及手术结束时的气道峰压和喉罩气道密封压。记录拔出人工气道时及之后30 min内有无低氧血症(SpO_290%)、喉痉挛、呛咳、呕吐、咽喉痛,人工气道的套囊和管壁内外有无血迹和污物。结果:不同时间点比较,FLMA组SBP、DBP、HR在T2与T1间、T4与T3间差异无统计学意义(P0.05);RTT组SBP、DBP、HR在T2比T1明显升高(P0.01),T4比T3明显升高(P0.05)。两组间比较,T2和T4时FLMA组SBP、DBP和HR均明显低于RTT组(P0.05)。两组内及两组间各时点气道峰压及纤维支气管镜分级比较,差异均无统计学意义(P0.05)。拔出人工气道时及拔出后30 min内,FLMA组的呛咳、咽喉痛及声音嘶哑发生率明显小于RTT组(P0.05)。结论:在严格掌握适应征的前提下,FLMA可用于俯卧位腰椎手术的机械通气,其安全性有待进一步临床验证。与RTT相比较,FLMA围术期循环波动更小,术后呼吸道并发症更少。
[Abstract]:Objective: To evaluate the safety and feasibility of flexible laryngeal mask airway (FLMA) for prostrate lumbar spine surgery. Methods: 120 patients with selected lumbar surgery were randomly divided into group FLMA and steel wire (reinforced tracheal tube, RTT). After general anesthesia induction, FLMA or RTT were placed respectively, and the induced opening was recorded. T0, artificial airway implantation (T1), 1 min (T2) after implantation and pullout (T3), 1 min (T4) heart rate (heart rate, HR), systolic pressure (systolic blood) and diastolic pressure. At the beginning of the operation, 1 h after the operation, 2 h after the operation and the peak pressure of the airway and the sealing pressure of the laryngeal airway at the beginning of the operation were recorded at the beginning of the operation. When the artificial airway was drawn out, there were no hypoxemia (SpO_290%), laryngospasm, choking, vomiting, sore throat, and blood without blood at and outside the wall of the artificial airway at the beginning of the operation. Results: FLMA group SBP, DBP, HR in T2 and T1, there was no statistical difference between T4 and T3 at different time points. The RTT group SBP, DBP, and HR were significantly higher than those in the two groups. The difference of peak pressure and fiberoptic bronchoscopy was not statistically significant (P0.05). The incidence of choking, sore throat and hoarseness in group FLMA was significantly lower than that in group RTT (P0.05). Conclusion: FLMA can be used for mechanical ventilation in the prone position of lumbar vertebra operation, and the safety of FLMA is safe. There is a need for further clinical validation. Compared with RTT, FLMA has less circulatory fluctuation during perioperative period and fewer postoperative respiratory complications.

【作者单位】：北京大学第一医院麻醉科;
【分类号】：R614.2

【相似文献】