AuraFlex喉罩在老年患者脊柱外科手术中的应用  

Safety of AuraFlex laryngeal mask airway used for spinal sugery in aged patients

作　　者：郑义林[1] 宋文芳[1] 王东信[1] ZHENG Yilin;SONG Wenfang;WANG Dongxin(Department of Anesthesiology,The First Hospital,Peking Uni-versity,Beijing 100034,China)

机构地区：[1]北京大学第一医院麻醉科,100034

出　　处：《临床麻醉学杂志》2018年第7期665-668,共4页Journal of Clinical Anesthesiology

摘　　要：目的观察AuraFlex喉罩在老年患者脊柱外科手术中应用的安全性和有效性。方法选择择期全麻下脊柱外科俯卧位手术的老年患者127例,男74例,女53例,年龄65~79岁,体重45~90kg,BMI 18.5~25.0kg/m2,ASAⅡ或Ⅲ级,随机分为两组:喉罩组(L组)和气管导管组(T组),全麻诱导后分别置入AuraFlex喉罩(L组)或钢丝加强型气管导管(T组)。记录诱导开始前(T0)、人工气道置入前(T1)、置入后1min(T2)、置入后3 min(T3)、拔除前(T4)、拔除后1 min(T5)、拔除后3min(T6)的HR、SBP、DBP。记录置入时间、置入次数。记录平卧位改俯卧位前后气道峰压(Ppeak)、喉罩气道密封压(PAS)和纤维支气管镜检查分级(FBS)。记录手术开始时、手术开始后1h、手术开始后2h和手术结束时Ppeak和PAS。记录拔管前FBS。记录拔除人工气道时至拔除后30min内,有无低氧血症(SpO2<90%)、喉痉挛、呛咳、呕吐、咽喉痛,人工气道的套囊或管壁内外有无血迹和污物。结果与T0时比较,T2、T3、T5时T组HR明显增快、SBP和DBP明显升高(P<0.05或P<0.01),且明显高于L组(P<0.05或P<0.01)。两组组内组间不同时点Ppeak和纤维支气管镜分级差异均无统计学意义。人工气道拔出时和拔出后30min内,L组的呛咳、咽喉痛发生率和低氧血症、声音嘶哑发生率明显低于T组(P<0.05或P<0.01)。结论在选择好适应证和加强监测的前提下,相较于钢丝加强气管导管,应用AuraFlex喉罩围术期循环更稳定,术后呼吸道并发症更少,可以安全有效地用于老年患者脊柱外科手术。Objective To estimate the security and feasibility of AuraFlex laryngeal mask airway for spinal surgery in aged patients.Methods One hundred and twenty-seven elderly patients scheduled for lumbar spine operation or cervical vertebra surgery under intravenous general anesthesia,74 males and 53 females,aged 65-79 years,weighting 45-90 kg,BMI 18.5-25.0 kg/m2,ASA physical status Ⅱ or Ⅲ,were randomly divided into two groups（n=65）：AuraFlex LMA group（group L）and reinforced tracheal tube group（group T）.HR,SBP and DBP were recorded before anesthesia induction（T0）and before intubation（T1）,1 min after intubation（T2）,3 min after intubation（T3）,before extubation（T4）,1 min after extubation（T5）,3 min after extubation（T6）as well.Duration and times of insertion were recorded.Peak airway pressure（Ppeak）,airway sealing pressure（PAS）and Fiberoptic Bronchoscopy Scale（FBS）were recorded in supine and prone position,at the start of surgery,1 hand 2 hlater,the end of surgery,and before extubation.Finally,respiratory complications after extubation were observed.Results HR,SBP and DBP in group T were significantly higher than in group L at T2,T3 and T5（P〈0.01 or P〈0.05）,as well as significantly higher at T2 than T0 and T5 than T4（P〈0.01 or P〈0.05）.Ppeak in group L as the same as in group T as well as FLS.With less hypoxia and hoarseness in group L,the incidences of coughing and pharyngalgia after extubation were significantly lower in group L than in group T（P〈0.01 or P〈0.05）.Conclusion Under suitable conditions,auraflex laryngeal mask airway can be safely used in aged patients undergoing spinal surgery,which even is superior to reinforced tracheal tube in some aspects.

关 键 词：气道管理 喉面罩 脊柱 老年 

分 类 号：R614[医药卫生—麻醉学]