中耳炎手术中头部位置改变对可弯曲喉罩通气效果的影响  

Impact of head position on airway management with flexible laryngeal airway mask in the patients undergoing otitis media surgery

作　　者：冉国 徐睿[1] 伍金红[1] 贾继娥[1] 李文献[1] 

机构地区：[1]复旦大学附属眼耳鼻喉科医院麻醉科,200031

出　　处：《临床麻醉学杂志》2016年第10期976-979,共4页Journal of Clinical Anesthesiology

摘　　要：目的评价可弯曲喉罩在中耳炎手术患者中气道管理的安全性和有效性。方法选择本院2015年10月至2016年3月择期行中耳炎手术的患者76例,男32例,女44例,年龄18~65岁,BMI 18~25kg/m^2,ASAⅠ或Ⅱ级。全麻诱导后,选择合适型号的喉罩,采用经典手指引导法置入LMA,然后进行机械通气。分别在头颈正中位和侧旋位后记录漏气压、套囊压以及15cm H2O压力控制下的呼出潮气量,并采用纤维支气管镜观察体位变换前后咽部解剖结构显露情况。结果 73例患者一次性成功置入可弯曲喉罩。与头颈正中位比较,侧旋位后的潮气量明显下降（P〈0.05）,但可以满足临床机械通气要求。头颈正中位和侧旋位时的套囊压、漏气压及纤支镜下咽部解剖结构显露情况差异无统计学意义。结论可弯曲喉罩可以安全应用于中耳炎手术患者。Objective To evaluate the effectiveness of airway management with flexible laryngeal airway mask（fLMA）in otitis media surgery.Methods A total of 76 patients,32males,44 females,18-65 years old,ASA Ⅰ orⅡ,and undergoing otitis media surgery were enrolled from October 2015 to March 2016.After anesthesia induction,selecting aappropriate size of fLMA,using the standard index finger-guided technique inserting the fLMA,and then the patients were ventilated mechanically.Cuff pressure,tidal volume,peak airway pressure and leakage pressure were recorded at the head position of frontal and lateral rotational.And the exposure of pharynx structures were viewed before and after the posture transformation by fiber bronchoscopy.Results Seventy-three patients were successfully placed with a fLMA at the first try,and no failure at the second try.Both head position ventilated with fLMA could meet the requirements of mechanical ventilation,though the tidal volume was decreased significantly at the lateral rotational position（P〈0.05）.Cuff pressure,peak airway pressure,leakage pressure and the exposure of pharynx structures were no significant difference before and after the posture transformation.Conclusion Airway management with flexible laryngeal airway mask was effective and safe in otitis media surgery.

关 键 词：中耳炎 头位 喉罩 潮气量 套囊压 漏气压 

分 类 号：R614.2[医药卫生—麻醉学]