第一代喉罩在胃肠肿瘤手术中的应用  

The Application of the First-generation Laryngeal Mask Airway during Gastrointestinal Cancer Surgery

作　　者：马长青[1] 杨少勇[1] 刘玲[1] 

机构地区：[1]天津医科大学附属肿瘤医院麻醉科,天津市300060

出　　处：《中国肿瘤临床》2006年第11期641-643,共3页Chinese Journal of Clinical Oncology

摘　　要：目的:探讨胃肠肿瘤手术患者,应用第一代喉罩通气的安全性与可行性。方法:45例ASAⅠ～Ⅲ级胃癌、结肠癌手术的患者,术前置胃管接多功能负压引流袋引流,在静脉复合全身麻醉下,插入第一代喉罩替代气管内插管维持通气。以纤维支气管镜根据喉罩定位标准记录分级。观察通气时潮气量和气道压力与喉罩气囊漏气的关系,记录胃肠肿瘤手术的胃内容物引流量、口腔内返流量、胃胀气情况。结果:全部病例纤维支气管镜定位2级(可见声门口和会厌)在机械通气维持潮气量6ml/Kg,气道压力均<20cmH2O时,无明显气道漏气,当试验性加大潮气量>800ml,气道压>30cmH2O时,有35例气道漏气,占77.8%。未发现胃内容物口腔内返流及胃胀气,胃内引流量均<30ml。结论:喉罩罩口与声门口对位准确可减低气道压,有效防止气道漏气。胃管在胃内持续负压引流可减少胃胀气,有效防止胃内容物返流。Objective： To study the safety and effectiveness of the first-generation laryngeal mask airway （LMA） during general anesthesia of patients undergoing gastrointestinal cancer surgery. Methods： Forty-five patients （ASA, Ⅰ-Ⅲ） undergoing elective gastrointestinal cancer surgery were intubated with an indwelling gastrointestinal drainage catheter preoperatively. After the anesthetic induction, the first-generation LMA was inserted and a fibreoptic bronchoscope （FOB） was used to ensure correct positioning of the LMA. The relationship of tidal volume, airway pressure and leakage of the LMA cuff during mechanical ventilation was noted. The volume of fluid drained from the gastrointestinal tract and if the gas insufflated into the stomach were observed. Results： All the cases were evaluated as grade Ⅱ by the FOB. The glottis and the epiglottis could be seen for the placement of LMA. No air leakage was observed when the tidal volume maintained at 6 ml/Kg and the peak airway pressure was less than 20 cm H2O. Airway leakage was observed in 77.8% （35/45） of the patients as the tidal volume increased to 800 ml and higher or the peak pressure increased to 30 cm H2O. In all of the patients participating in this study, no regurgitation or aspiration of gastric contents was found. The volume of drained fluid was less than 30 ml. Conclusion： The correct contraposition of the LMA between the mouth and glottis in the throat can decrease the peak pressure of the airway and can effectively prevent airway leakage. The continuous negative pressure drainage of the gastric tube in the stomach can decrease the gaseous distention of the stomach, circumvent the need for insertion of a decompression catheter into the stomach, and may prevent the regurgitation of gastric contents.

关 键 词：胃肠肿瘤 第一代喉罩 胃管 负压引流 

分 类 号：R735[医药卫生—肿瘤] R614[医药卫生—临床医学]