侧卧位肾切除术中应用双管喉罩辅助呼气末正压通气改善肥胖患者呼吸功能的前瞻性研究  

Prospective Audit on the Use of the LMA-SupremeTMfor Airway Management of Adult Obeses Patients with Positive End-expiratory Pressure in Nephrectomy in Lateral Position

作　　者：赵晓春[1] 张立民[1] 龙波[1] 王聪[1] 

机构地区：[1]中国医科大学附属盛京医院麻醉科,沈阳110004

出　　处：《中国医科大学学报》2014年第1期10-13,共4页Journal of China Medical University

基　　金：国家自然科学基金(81000824)

摘　　要：目的探讨一次性双管喉罩(SLMA)在肥胖患者侧卧位肾切除术中行呼气末正压通气(PEEP)的应用。方法 30例需行侧卧位肾切除术的肥胖患者(BMI>30 kg/m2,<36 kg/m2)随机分为3组(GroupⅠ,Ⅱ,Ⅲ),均使用SLMA进行气道管理。容量控制通气模式下,GroupⅠ加入PEEP=5 cmH2O;GroupⅡ加入PEEP=10 cmH2O;GroupⅢ作为对照组,只行容量控制通气。观察SLMA进行气道管理的安全性和有效性,同时比较两组肥胖患者术前、术中60 min和术后2 h的血气分析结果。结果一次性双管喉罩在所有行侧卧位肾切除术的肥胖患者中均插入成功,术中无明显异常发生。GroupⅠ、GroupⅡ在术中60 min的动脉氧分压均高于GroupⅢ(P<0.05。GroupⅡ在术后2 h的动脉氧分压高于GroupⅠ和GroupⅢ(P<0.05)。结论 SLMA可以安全有效地应用于侧卧位肾切除术中肥胖患者的气道管理。在使用SLMA进行气道管理的肥胖患者中,容量控制通气辅助PEEP=10cm H2O可以有效改善侧卧位肾切除术围术期的氧合并减少肺不张。Objective To evaluate the use of the LMA-SupremeTM （SLMA） for airway management of adult obese patients with positive end-expira- tory pressure （PEEP） in nephrectomy in Lateral position. Methods A total of 30 consecutive adult obese patients who were inserted by SLMA un- der volume-controlled mechanical ventilation （VCV） in the study with PEEP were divided into three groups （ Group I , l] , m ）. Group I ： PEEP of 5 cmH20 ; Group ]] ： PEEP of 10 cmH20 ; Group m ： only VCV. Results There were no failures of SLMA insertion or maintenance of VCV during surgery for adult obese patients. Groups were comparable with respect to demographic data. Compared with Group m, PaO2 in Group I and Ⅱ was sig- nificantly （ P 〈 0.05 ） higher at 60 rains after anesthesia induction. Patients in Group Ⅱ showed higher PaO2 in PACU than Groups I and m. Conclu- sion SLMA is a useful alternative to tracheal intabation for adult obese patients in nephrectomy in lateral position. Intraoperative VCV followed by PEEP 10 cm H2O is effective in preventing lung atelectasis and is associated with better oxwenation.

关 键 词：一次性双管喉罩 呼气末正压通气 俯卧位 

分 类 号：R69[医药卫生—泌尿科学]