加强引流型喉罩在老年患者鼻内镜手术中的应用  

Application of a reinforced laryngeal mask airway with drain tube in elderly patient undergoing endoscopic sinus surgery

作　　者：张宏业[1] 吴冬金[2] 左明章[1] 

机构地区：[1]北京医院麻醉科,100730 [2]厦门大学附属第一医院麻醉科,厦门361003

出　　处：《中华老年医学杂志》2016年第4期387-390,共4页Chinese Journal of Geriatrics

摘　　要：目的探讨加强引流型喉罩在老年患者鼻内镜手术中应用的有效性和安全性。方法选取60例择期行鼻内镜手术的老年患者，随机分为加强引流型喉罩组（R组）和钢丝加强型气管导管组（T组），比较两组气管导管置入难易度、成功置入所需时间、成功置入所需次数、纤维支气管镜对位分级、胃管置入难易度、口咽漏气压（OLP）、术中气道质量；记录术中特定时间点通气指标、插管以及拔管时血流动力学指标、拔除喉罩后喉罩血迹沾染情况；记录术后1h、6h以及24h气道相关并发症的发生情况。结果两组患者一般状况、首次置入成功率、置入总成功率、术中气道质量以及麻醉药物用量差异均无统计学意义；与T组30例患者（45．4±15．6）s比较，R组29例患者气管导管置入时间（34．1±13．0）S，明显缩短（t=5．274，P=0．001）；T组患者拔管时呛咳发生率为53．3％（16／30），而R组患者均未发生呛咳（x2=21．222，P=0．000）。结论加强引流型喉罩可安全有效地应用于老年患者鼻内镜手术。Objective To investigate the safety and efficiency of a reinforced laryngeal mask airway（LMA） with drain tube in elderly patient undergoing endoscopic sinus surgery. Methods Sixty elderly patients were selected and randomly divided into two groups： a reinforced LMA group （group R, n= 30）and a reinforced endotracheal tube group（group T, n= 30）. Observation items include the difficulty degree of device insertion, the time for successful insertion, the number of attempts required for successful insertion, fiberoptic view of glottis, the difficulty degree of gastric tube insertion,oropharyngeal leak pressure （OLP）, ventilatory indicators at a certain time, haemodynamics during insertion, the blood stain on the mask were compared between the two group. The postoperative complications 1,6, 24 hours after operation were recorded. Results There were no significant differences in general conditions, the successful insertion rate at first attempt, the total success insertion rate, airway quality and the anesthetic drug dosage between the two groups. The insertion time was shorter in group R than in group T [（34.1 ± 13.0 s） vs （45.4 ＋[ 15.6 s）, t = 5. 274, P = 0. 001]. The incidence of cough during extubation was less in group R than in group T [0% （0/30） vs. 53.3%（16/30）,x2=21.222,P=0.0001. Conclusions The reinforced LMA with drain tube is safe and effective for elderly patients during endoscopic sinus surgery.

关 键 词：插管法 气管内 内窥镜检查 

分 类 号：R614[医药卫生—麻醉学]