耳科手术中改变头位对可弯喉罩对位及通气的影响  

The influence of head position on ventilation and cuff position of flexible laryngeal mask in otology surgery

作　　者：刘飞红 崔旭[1] 王惠军[1] 王古岩 奚春花[1] Liu Feihong;Cui Xu;Wang Huijun;Wang Guyan;Xi Chunhua(Department of Anesthesiology, Beijing Tongren Hospital,Capital Medical University, Beijing 100730, China)

机构地区：[1]首都医科大学附属北京同仁医院麻醉科

出　　处：《北京医学》2019年第8期664-666,共3页Beijing Medical Journal

摘　　要：目的探讨耳科手术中改变头位对可弯喉罩对位及通气的影响。方法选取2016年3~9月首都医科大学附属北京同仁医院拟行择期中耳成型术的患者100例,全身麻醉诱导后,根据体质量选择合适的喉罩,置入喉罩后行机械通气,潮气量为8 ml/kg。分别于诱导后头正位、术前头侧位及术毕包扎时头屈位记录气道压、漏气压及喉罩囊内压(以下简称套囊压),采用纤维支气管镜(fiberoptic bronchoscope, FOB)记录3种体位时喉罩对位评分及旋转评分。结果4例因3次试插喉罩通气失败改为气管插管,96例患者可成功行喉罩通气。与头正位相比,头偏位可使套囊压显著降低(P <0.05),但对气道压及漏气压的影响无统计学意义。包扎时头屈位可增高气道压及套囊压,差异均有统计学意义(P <0.05)。FOB检查显示,头偏位可显著改善对位(P <0.05),而头屈位则显著影响对位(P <0.001),两种体位改变对喉罩旋转影响差异无统计学意义(P>0.05)。结论在头正位通气良好的情况下,耳科手术头部侧偏可改善可弯喉罩对位,不影响气道压及漏气压。包扎时头屈位则影响喉罩对位,可导致气道压增高。Objective To investigate the influence of head position on cuff position and ventilation of flexible laryngeal mask in otology surgery. Methods One hundred patients scheduled to undergo tympanoplasty were selected in Beijing Tongren Hospital from March to September 2016. After induction of general anesthesia, appropriate laryngeal mask was selected according to body weight, and mechanical ventilation was performed with a volume-controlled mode after placement of laryngeal mask. The tidal volume was 8 ml/kg. The peak pressure, oropharyngeal leak pressure and laryngeal mask cuff pressure were recorded for the neutral head position after induction, rotated head position before surgery and the flexed head position when dressing the wound. The cuff position score and rotation score were recorded by fiberoptic bronchoscope(FOB) in the three positions. Results Laryngeal mask ventilation were successfully performed in 96 patients, while 4 cases were changed to tracheal intubation due to the failure of three trials of laryngeal mask ventilation. Compared with the neutral head position,the rotated head position significantly reduced cuff pressure(P < 0.01), but had no significant effect on the peak pressure and the oropharyngeal leak pressure. There were significant differences in peak pressure and cuff pressure when the head was flexed(P < 0.01). FOB examination showed that rotated head significantly improved the cuff position(P < 0.001), while flexed head significantly affected the cuff position(P < 0.001). There was no significant difference in the rotation score of the two postural changes. Conclusions Under the condition of well ventilation in the neutral head position, the rotated position of the head can improve the cuff position of flexible laryngeal mask without affecting the peak pressure and the oropharyngeal leak pressure in otology surgery. Flexed head affects the cuff position and may result in increased airway pressure.

关 键 词：喉罩 对位 中耳手术 头位 纤维支气管镜评分 

分 类 号：R614[医药卫生—麻醉学]