老年患者全身麻醉下纤维支气管镜检查术喉罩与面罩通气的比较  

Comparison of general anesthesia of laryngeal mask and mask ventilation during bronchoscopy in elder patients

作　　者：罗兵[1] 阮祥才[1] 许立新[1] 魏树全[1] 应彦璐[1] 郭静文[1] 

机构地区：[1]广州市第一人民医院麻醉科,510180

出　　处：《实用医学杂志》2014年第16期2595-2598,共4页The Journal of Practical Medicine

摘　　要：目的：比较喉罩与面罩通气方式用于老年患者纤维支气管镜（纤支镜）检查术的效果。方法：120例ASAⅠ~Ⅲ级的老年患者,根据通气方式的不同随机分为表面麻醉自主呼吸组（Ⅰ组,n=40）、内镜面罩通气组（Ⅱ组,n=40）和喉罩通气组（Ⅲ组,n=40）,其中Ⅰ组经鼻导管吸氧、Ⅱ组通过内镜面罩供氧、Ⅲ组插入喉罩控制呼吸。观察术中通气效果、不良反应,记录患者纤支镜检查前、中、后的心率（HR）、平均血压（MAP）、血氧饱和度（SpO2）、血浆去甲肾上腺素的变化以及患者和镜检医师满意度。结果 ：与Ⅰ组比较,Ⅱ组和Ⅲ组手术条件好,不良反应少,检查中MAP、HR和NE波动变化小,手术耗时短,完成度高,患者术后满意度高,差异有统计学意义（P〈0.01或P〈0.05）;Ⅱ组呼吸抑制、呼吸道梗阻发生率、手术耗时高于Ⅲ组（P〈0.05）。结论：面罩和喉罩均可安全用于老年人全身麻醉下支气管镜检查术气道管理,后者具有通气可靠、血流动力学平稳和便利的优势,值得临床推荐。Objective To evaluate the different effects of laryngeal mask and mask ventilation during bronchoscopy in elder patients. Methods 120 old patients （ASA Ⅰ-Ⅲ） were divided into three group according to the table of random number as following：surface anesthesia with autonomous respiration （group I）;endoscope mask ventilation （group Ⅱ）;laryngeal mask airway ventilation （group Ⅲ）. Oxygen inhalation through nasal tube in groupⅠ,group Ⅱ and group Ⅲwas ventilated with endoscope mask and LMA respectively ,thenwe observed whether there were adverse effects or not during the procedure. Results The adverse reactions of group Ⅰ were more than other groups. Compared with the group Ⅰ, variance of MAP,HR, RR, SpO2 in the groupⅡand groupⅢ had less changes, the cases with severe bucking decreased significantly, and satisfaction degree increased markedly, （P 〈0.01or P〈0.05 ） . The incidence rate of resp iratory depression and airway obstruction in groupⅡwas higher than that in groupⅢ （P〈0.05）. Conclusion Endoscope mask ventilation and LMA can both be adopted in analgesia bronchoscopy for old patient. LMA under general anesthesia to transbronchial lung biopsy would control respiration according to the demand at any time.LMA has more advantage in the operation for the stable respiration and hemodynamics and less complications.

关 键 词：喉罩 通气 支气管镜检查术 老年人 

分 类 号：R614[医药卫生—麻醉学]