本文選題：氣道管理 + 插管法��； 參考：《北京大學(xué)學(xué)報(bào)(醫(yī)學(xué)版)》2017年02期

【摘要】：目的:評(píng)價(jià)可彎曲喉罩(flexible laryngeal mask airway,FLMA)用于俯臥位腰椎手術(shù)的安全性和可行性。方法:擇期腰椎手術(shù)患者120例,隨機(jī)均分為FLMA組和鋼絲加強(qiáng)氣管導(dǎo)管(reinforced tracheal tube,RTT)組,全身麻醉誘導(dǎo)后分別置入FLMA或RTT,記錄誘導(dǎo)開始時(shí)(T0)、人工氣道置入時(shí)(T1)、置入后1 min(T2)及拔出時(shí)(T3)、拔出后1 min(T4)的心率(heart rate,HR)、收縮壓(systolic blood pressure,SBP)和舒張壓(diastolic blood pressure,DBP)。記錄置入時(shí)間、置入次數(shù)以及平臥位和俯臥位后氣道峰壓、喉罩氣道密封壓和纖維支氣管鏡檢查分級(jí),記錄手術(shù)開始時(shí)、手術(shù)開始后1 h、手術(shù)開始后2 h及手術(shù)結(jié)束時(shí)的氣道峰壓和喉罩氣道密封壓。記錄拔出人工氣道時(shí)及之后30 min內(nèi)有無(wú)低氧血癥(SpO_290%)、喉痙攣、嗆咳、嘔吐、咽喉痛,人工氣道的套囊和管壁內(nèi)外有無(wú)血跡和污物。結(jié)果:不同時(shí)間點(diǎn)比較,FLMA組SBP、DBP、HR在T2與T1間、T4與T3間差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);RTT組SBP、DBP、HR在T2比T1明顯升高(P0.01),T4比T3明顯升高(P0.05)。兩組間比較,T2和T4時(shí)FLMA組SBP、DBP和HR均明顯低于RTT組(P0.05)。兩組內(nèi)及兩組間各時(shí)點(diǎn)氣道峰壓及纖維支氣管鏡分級(jí)比較,差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。拔出人工氣道時(shí)及拔出后30 min內(nèi),FLMA組的嗆咳、咽喉痛及聲音嘶啞發(fā)生率明顯小于RTT組(P0.05)。結(jié)論:在嚴(yán)格掌握適應(yīng)征的前提下,FLMA可用于俯臥位腰椎手術(shù)的機(jī)械通氣,其安全性有待進(jìn)一步臨床驗(yàn)證。與RTT相比較,FLMA圍術(shù)期循環(huán)波動(dòng)更小,術(shù)后呼吸道并發(fā)癥更少。
[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.

【作者單位】： 北京大學(xué)第一醫(yī)院麻醉科;
【分類號(hào)】：R614.2

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