可弯曲喉罩在颌面外科日间手术的应用  

Application of flexible laryngeal mask airway in oral & maxillofacial day surgery

作　　者：葛娜[1] 关明[1] 李茜[1] 李率[2] 王恩博[1] 

机构地区：[1]北京大学口腔医学院.口腔医院口腔颌面外科,北京100081 [2]北京大学口腔医学院.口腔医院种植科,北京100081

出　　处：《北京大学学报（医学版）》2015年第6期1010-1014,共5页Journal of Peking University:Health Sciences

摘　　要：目的：探讨可弯曲喉罩在颌面外科日间手术全身麻醉治疗中应用的可行性、安全性。方法：回顾性研究北京大学口腔医院口腔颌面外科门诊在全身麻醉治疗中应用可弯曲喉罩的日间手术病例40例（3~61岁）,其中男性19例,女性21例,均为美国麻醉医师协会（American Society of Anesthesiologists,ASA）分级Ⅰ~Ⅱ级。术中监测不同时间点,即入室麻醉前（T0,基线值）、插入喉罩后即刻（T1）、手术切开时（T2）、术中15 min（T3）、术毕时（T4）5个时间点的患者生命体征指标,记录喉罩首次置入成功率及改为气管内插管的比例。记录术中体动、低氧血症、呼吸道梗阻情况,记录手术时间、麻醉时间、术毕至拔除喉罩时间、拔除喉罩时体动、呛咳及术后24 h咽痛发生率。术后24 h随访记录有无手术相关并发症（如出血、血肿、及术区神经损伤情况）。结果：40例患者均顺利完成手术,36例患者成功使用可弯曲喉罩（90%,36/40）,男性16例,女性20例,其中喉罩首次置入成功率80%（32/40）,二次尝试成功率50%（4/8）。4例不成功的患者中,3例患者第二次尝试置入喉罩位置仍不理想,改为气管内插管方式;1例患者第二次尝试,喉罩虽顺利置入,但在手术开始前发现胃部胀气,改为气管内插管。36例应用喉罩患者,平均手术时间（46.58±22.57）min,平均麻醉时间（77.97±26.82）min,术毕至拔除喉罩时间（8.31±3.33）min。术中患者均无明显体动,拔除喉罩时轻微体动者11.11%（4/36例）,均无呛咳。术后24 h喉罩组咽痛发生率13.89%（5/36例）。术后无手术治疗相关出血、血肿及术区神经损伤等严重并发症。患者清醒状态下各生命体征基线值T0与麻醉后各时点的数值T1、T2、T3、T4比较,P〈0.01,差异有统计学意义。心率在麻醉后各时点数值T1、T2、T3、T4两两比较,P〉0.05,差异无统计学意义。收缩压与舒张压在麻醉后各�Objective： To access the feasibility and safety of application of flexible laryngeal mask airway（ FLMA） in oral maxillofacial day surgery. Methods： Retrospective study was conducted of 40 oral maxillofacial day surgery patients（ 3 to 61 years of age） using FLMA under general anaesthesia in Department of Oral Maxillofacial Surgery,Peking University School and Hospital of Stomatology. All the patients were with American Society of Anesthesiologists（ ASA） physical status Ⅰ-Ⅱ,including 19 males and 21 females. The patients＇ vital signs were recorded at five different time points： baseline before anesthesia（ T0）,time right after the FLMA insertion（ T1）,time at incision（ T2）,15 min after incision（ T3） and time at the end of the operation（ T4）. The first attempted FLMA insertion successful rate and the number of timed of changing to endotracheal intubation were recorded. During operation,frequencies of movement,hypoxia and obstruction of airway were noted and the operation time,anesthesia time,time from the end of the operation to extubation,movement and coughing following extubation and sore throat within 24 h were taken down. Operation-related complications of bleeding,hematoma and injury of local nerves were recorded within 24 h as well. Results： The operations of all the 40 patients were successfully done under general anaesthesia. The 36（ 90%,36 /40） patients using FLMA successfully were under steady process,including 16 males and 20 females. The first attempted successful rate of FLMA insertion was 80%（ 32 /40）,and the second 50%（ 4 /8）. Three out of the 4 failed FLMA patients were changed to endotracheal intubation after the second attempt failed. The other patient was changed to endotracheal intubation before operation because of leak. The average operation time was（ 46. 58 ± 22. 57） min,the anesthesia time was（ 77. 97 ± 26. 82） min and the time from the end of operation to extubation was（ 8. 31 ± 3. 33） min. All the patients were recorded

关 键 词：喉罩 日间手术 外科 口腔 手术后并发症 

分 类 号：R782.054[医药卫生—口腔医学]