發(fā)布時(shí)間：2018-04-02 22:28

  本文選題：女性　切入點(diǎn)：喉罩　出處：《皖南醫(yī)學(xué)院》2017年碩士論文

【摘要】：目的:喉罩(Laryngeal Mask Airway,LMA)作為聲門上通氣設(shè)備,因其操作簡單、創(chuàng)傷應(yīng)激小、心血管反應(yīng)弱及術(shù)后并發(fā)癥發(fā)生率低等優(yōu)點(diǎn)在臨床上廣為應(yīng)用,目前已成為國內(nèi)、外全身麻醉手術(shù)氣道管理的常用工具。選擇合適的喉罩型號(hào)是確保喉罩位置放置準(zhǔn)確,對(duì)位良好,保證安全有效通氣的前提。一直以來,體重都是廠家推薦作為選擇喉罩型號(hào)的標(biāo)準(zhǔn)。然而,臨床實(shí)踐發(fā)現(xiàn)基于患者體重選擇喉罩型號(hào)有時(shí)并不能保證喉罩型號(hào)選擇的準(zhǔn)確性,且該方法也并未體現(xiàn)出臨床上的優(yōu)勢。目前,目測患者口腔容積經(jīng)驗(yàn)性選擇喉罩型號(hào)是多數(shù)麻醉醫(yī)生常用的方法,但尚缺乏一定的研究依據(jù)。因此,本研究擬通過探究患者的體重、身高、張口度、口角距離、下頜角距離和甲頦距離等多種因素與喉罩型號(hào)選擇間的相關(guān)性,旨在找出影響女性喉罩型號(hào)精確選擇的相關(guān)因素,為臨床女性喉罩型號(hào)的選擇提供合理有效的方法,為全身麻醉喉罩通氣管理作指導(dǎo)。方法:選取擇期全身麻醉手術(shù)需喉罩通氣的成年女性患者400例,ASA I-II級(jí),年齡18-70歲。排除合并有重要系統(tǒng)器官疾病、有大量返流誤吸風(fēng)險(xiǎn)、曾接受過咽喉部手術(shù)史、需進(jìn)行頭頸部手術(shù)等患者。手術(shù)麻醉前測量患者的體重、身高、張口度、口角距離、下頜角距離以及甲頦距離。麻醉誘導(dǎo)后依據(jù)經(jīng)驗(yàn)選擇合適型號(hào)的喉罩,并置入。記錄患者喉罩的置入次數(shù)、纖支鏡評(píng)分和氣道密閉壓。單因素分析運(yùn)用獨(dú)立樣本t檢驗(yàn)或方差分析,多因素分析采用Logistic回歸分析,并聯(lián)合受試者工作特征曲線(receiver operating characteristic curve,ROC)及曲線下面積(area under the curve,AUC),評(píng)估各因素對(duì)喉罩型號(hào)選擇的預(yù)測性能。結(jié)果:本研究共選擇了擬在全身麻醉下行喉罩通氣手術(shù)的成年女性患者400例,其中,2例患者由于臨時(shí)直接更改了氣管內(nèi)導(dǎo)管插管行術(shù)中氣道管理而排除在外。單因素分析發(fā)現(xiàn),體重、張口度、下頜角距離、口角距離和甲頦距離與喉罩型號(hào)的選擇具有明顯的相關(guān)性(p0.05),身高與喉罩型號(hào)的選擇無相關(guān)性(p0.05);Logistic回歸多因素分析示,口角距離、張口度、下頜角距離、以及甲頦距離與喉罩型號(hào)選擇相關(guān)(p0.05),其OR值分別為33.255、2.869、6.364、1.878,而體重與喉罩型號(hào)的選擇并無相關(guān)性(p0.05)。ROC曲線分析示,體重、體重指數(shù)、口角距離、下頜角距離、張口度、甲頦距離和Logistic回歸模型新變量Pre-1的曲線下面積(AUC)分別為0.701、0.708、0.766、0.704、0.604、0.611、0.882。結(jié)論:體重、口角距離、下頜角距離、張口度、甲頦距離均能影響成年女性Supreme喉罩型號(hào)的選擇;口角距離用于判斷女性Supreme喉罩型號(hào)的選擇具有較高的可靠性;依據(jù)經(jīng)驗(yàn)綜合考慮患者體重、體重指數(shù)、口角距離、下頜角距離、張口度和甲頦距離選擇喉罩型號(hào)較單一體重因素更具有臨床優(yōu)勢。
[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.
【學(xué)位授予單位】：皖南醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R614

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本文編號(hào)：1702418