三通喉罩用于全麻下球囊扩张气道成形术的气道管理  

Clinical appliation of three-way laryngeal mask in airway management of balloon dilatation bronchoplasty under general anesthesia

作　　者：宋炯[1] 段若望[1] 

机构地区：[1]同济大学附属上海市肺科医院麻醉科,200433

出　　处：《临床麻醉学杂志》2013年第1期45-48,共4页Journal of Clinical Anesthesiology

基　　金：上海市级医院适宜技术联合开发推广应用项目(SHDC12010214)

摘　　要：目的评价三通喉罩用于全麻下球囊扩张气道成形术气道管理的效果。方法选择我院在全麻下行球囊扩张气道成形术患者38例,ASAⅠ或Ⅱ级,男9例,女29例,年龄16～65岁,体重38～74kg。根据狭窄的部位将所有病例分为气管狭窄组(A组,包括气管、支气管复合狭窄患者)13例,气管以下部位狭窄组(B组)25例。入室后快速诱导,置入三通喉罩,丙泊酚和维库溴铵维持麻醉。经三通喉罩操作孔置入纤维支气管镜进行球囊扩张气道成形术。分别记录入室后(基础值,T0),置入喉罩即刻(T1),扩张开始前(T2),扩张时(T3),扩张结束后(T4),术毕(T5)时HR,SBP,DBP和SpO2;记录T1～T5时VT、气道峰压(Ppeak)和PETCO2,并于T0、T2～T5时采集桡动脉血进行血气分析。结果与T0时比较,除A组T3时外,所有患者各时点SpO2均明显升高(P<0.01),T2～T5时两组患者的PaCO2明显降低,PaO2、SaO2明显升高(P<0.05或P<0.01);而pH值、HCO-3差异无统计学意义。与T1时比较,T3时B组VT、PETCO2明显降低(P<0.01),而A组暂停控制呼吸;T4、T5时两组VT、RR、Ppeak和PETCO2差异无统计学意义。结论三通喉罩用于全麻下球囊扩张气道成形术的通气管理效果良好,术后并发症少,为球囊扩张气道成形术的广泛开展打下了基础。Objective To evaluate the effect of appliation of three-way laryngeal mask in airway management of balloon dilatation bronchoplasty under general anesthesia. Methods Thirty-eight ASA Ⅰ orⅡ patients of both sexes（9 male, 29 female） aged 16-65 years, weighing 38-74 kg, underwent balloon dilatation bronchoplasty under general anesthesia in shanghai pulmonary hospital, were divided into 2 groups according to the location of stenosis., tracheal stenosis （group A, n= 13） and bronchial stenosis （group B,n=25）. The three-way laryngeal mask was inserted after induction of anesthesia which was maintained with propofol and vecuronium. HR, SBP, DBP and SpO2 were recorded respectively before anesthesia （T0）, the time when inserting laryngeal mask （T1）, before dilatation（T2）, the time of dilatation（T3）, after dilatation（T4） and after operation（T5 ）. VT, Ppeak and PrrCO2 were recorded at T1-Ts. Radial artery was cannulated for blood gas analysis at To, T2- T5. Results As compared with To, SpO2 was improved significantly in all patients ventilated with the three-way laryngeal mask except at T3 in group A（P〈0. 01）, PaCO2 decreased and PaO2, SaO2 incresed significantly at T2-T5 in both groups（P〈0. 05 或 P〈0. 01）. Compared with T1, VT and PETCO2 at T3was obviously lower in group B（P〈0. 01）, while VT, RR, Ppeak and PsrCO2 at T4, Ts showed no statistical significance. Conclusion The three-way laryngeal mask could be effectively and safely used in airway management of balloon dilatation bronchoplasty under general anesthesia.

关 键 词：喉罩 狭窄 球囊扩张 

分 类 号：R614[医药卫生—麻醉学]