三种插管型喉罩在预测重度困难气道管理中的应用  

The use of Cookgas、Fastrach and CTrach intubating laryngeal mask airway in patients with anticipated severe difficult airways

作　　者：杨冬[1] 邓晓明[1] 郅娟 王玉慧[1] 张雁鸣[1] 佟世义[1] 唐耿志[1] 徐文莉[1] 隋静湖[1] 

机构地区：[1]中国医学科学院北京协和医学院整形外科医院麻醉科,100144

出　　处：《临床麻醉学杂志》2015年第1期42-46,共5页Journal of Clinical Anesthesiology

基　　金：首都临床特色应用研究基金(D101100050010002)

摘　　要：目的回顾性评价Cookgas、Fastrach和CTrach三种插管型喉罩在预测重度困难气道管理中应用的临床效果。方法 21例择期在全身麻醉下行整形外科手术的预测重度困难气管插管患者,Mallampati分级Ⅲ或Ⅳ级。麻醉医师通过个人判断自行决定插管型喉罩使用类型。收集、整理气管插管过程的全部信息。在21例患者中,7例患者采用Cookgas喉罩联合纤维光导支气管镜(Fibreoptic Bronchoscope,FOB)引导气管插管(Cookgas组),8例患者采用Fastrach喉罩联合FOB(Fastrach组)以及6例患者采用CTrach喉罩(CTrach组)完成气管插管。结果除Fastrach组1例喉罩置入失败,其余患者均成功置入插管型喉罩。Cookgas组7例患者均在两次内获得FOB引导气管插管成功;7例置入Fastrach喉罩的患者,有6例在FOB引导下成功完成气管插管,1例失败;CTrach组6例患者均获得首次气管插管成功。三组患者喉罩首次置入成功率差异无统计学意义,但Fastrach组和CTrach组喉罩置入时间分别为(33.3±15.5)s和(41.7±22.3)s,明显长于Cookgas组的(23.9±16.2)s(P<0.05)。结论 Cookgas、Fastrach和CTrach三种插管型喉罩均可安全、有效地应用于预测重度困难气管插管患者,但对于张口度小于15mm和/或颈部瘢痕重度挛缩或颈部置有巨大扩张器的患者,Cookgas喉罩具有明显优势。Objective To retrospectively assess the clinical use of Cookgas,Fastrach and CTrach Intubating Laryngeal Mask Airway（ILMA）in the management of predicted severe difficult airways.Methods Twenty-one patients with severe difficult airways（Mallampati score Ⅲ or Ⅳ,thyromental distance60mm,and mouth opening between 10-20mm）undergoing selective plastic surgery and requiring orotracheal intubation were enrolled in the study.The types of the ILMA were chosen by the anesthesiologists according to their favorite tools,however,the patients were intubated via Cookgas ILMA that whose mouth opening less then 15 mm,and/or with severe cervical scar contracture,or with the large expanders implanted in cervical area.The whole information of intubating procedures were collected and analyzed.Results All ILMA were inserted successfully,except one failure case in group Fastrach.7cases were intubated using Cookgas ILMA with fibreoptic bronchoscope（FOB）in group Cookgas.In group Fastrach,the intubations were finished at the first attempt in 6cases,one failed.The intubations were all successful at the first attempt in group CTrach.The degree of intubations successful at first attempt had no significant differences between the three groups.The time of intubating ILMA in group Fastrach（33.3±15.5）s and group CTrach（41.7±22.3）s was prolonged significantly than that in group Cookgas（23.9±16.2）s（P〈0.05）.Conclusion All three types of ILMA are safe and effective tools for predicted severe difficult airways,but Cookgas ILMA has obvious advantages for patients with at least one of these presences,such as mouth opening less then 15 mm,severe cervical scar contracture malformations,or large skin soft-tissue expanders implanted in cervical area.

关 键 词：插管型喉罩 困难气道 气管插管 

分 类 号：R614[医药卫生—麻醉学]