颈部超声指导小儿喉罩定位的可行性及应用效果  

Feasibility and application effect of cervical ultrasound guiding laryngeal mask placement in pediatric

作　　者：韩文栋 李红云[1] 杜晶慧[1] HAN Wendong;LI Hongyun;DU Jinghui(Department of Anesthesiology,Shanghai Children's Hospital,Children's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200062,China)

机构地区：[1]上海市儿童医院·上海市交通大学医学院附属儿童医院麻醉科,上海200062

出　　处：《西部医学》2025年第4期592-598,共7页Medical Journal of West China

基　　金：上海市卫生健康委员会科研课题计划项目(20204Y0470)。

摘　　要：目的比较超声测得的杓状软骨抬高角度与纤维支气管镜(FOB)检查获得的喉罩(LMA)定位分级的相应关系,探索使用颈部超声代替纤维支气管镜评估小儿喉罩位置的可行性。方法选取2022年3月—6月我院全身麻醉下择期手术的患儿160例。临床评估LMA位置正确后,先用FOB确认LMA位置,再用颈部超声在声门水平测量LMA发生旋转或移位时两侧杓状软骨不对称抬高的角度,分析两者之间的对应关系,并记录FOB下LMA分级、两侧杓状软骨的抬高角度(α)、临床测试是否阴性、口咽部漏气压(OLP)、术中是否胃肠胀气、LMA拔出后是否附着分泌物及术后是否咽喉疼痛。结果FOB定位LMA分级与颈部超声测量LMA发生旋转或移位两侧杓状软骨不对称抬高角度分级之间的一致性参数kappa系数为0.9116。当超声定位LMA发生旋转或移位时,杓状软骨不对称抬高的角度1级0°<α≤10°对应FOB下LMA分级Ⅰ级;2级10°<α≤20°对应FOB下LMA分级Ⅱ级;3级20°<α≤30°对应FOB下LMA分级Ⅲ级;4级α>30°对应FOB下LMA分级Ⅳ级。随着旋转角度分级的增加,高OLP比例随之降低(P<0.05);其次,术中胃肠胀气、拔出LMA后附着分泌物及术后咽喉疼痛的发生率均显著升高(P<0.05)。结论超声定位小儿LMA置入后杓状软骨抬高角度与FOB定位LMA分级具有较高的一致性,临床上通过超声实时诊断LMA位置,避免多次FOB检查加重低氧血症,同时为临床麻醉医生判断喉罩位置提供参考。Objective In this study,we compared the arytenoid elevation angle measured by ultrasound with the grade of laryngeal mask positioning obtained by fiberoptic bronchoscopy(FOB)and explored the feasibility and application value of neck ultrasound instead of FOB to assess the position of pediatric laryngeal mask airway(LMA),and determine the diagnostic value of cervical ultrasound in monitoring LMA rotation or displacement during pediatric LMA ventilation.Methods 160 children under general anesthesia were selected.After clinical assessment of correct placement of LMA,First,fibrobronchoscopy was placed to confirm the laryngeal mask airway position,and cervical ultrasound(USG)was used to observe the angle of asymmetric elevation of the arytenoid cartilage on both sides when the LMA rotated or shifted.The corresponding relationship between the angle and the position grading of the laryngeal mask under fiberoptic bronchoscopy was analyzed,LMA grading under FOB,elevation angle of the arytenoid cartilage on both sides(α),negative clinical test,oropharyngeal leak pressure(OLP),gastrointestinal flatulence during operation,secretions attached after LMA extraction,and postoperative throat pain were recorded.Results The consistency parameter kappa coefficient between the classification of LMA by FOB positioning and the asymmetric elevation angle of arytenoid cartilage on both sides of the rotated or displaced LMA measured by USG was 0.9116.When the laryngeal mask was rotated or shifted,the elevation angle(α)of arytenoid cartilage measured by ultrasound in the central transverse section of the neck was classified as follows:grade 1(mild rotation):0°<α≤10°,grade 2(moderate rotation):10°<α≤20°,grade 3(severe rotation):20°<α≤30°,and grade 4(extremely severe rotation):α>30°.Among the 160 children,150(93.75%)were successfully implanted with AMBU LMA at the first time,and the clinical test negative rate was 93.75%.10 children(6.25%)needed to be implanted for the second time due to positive clinical test.The proporti

关 键 词：超声 喉罩定位 纤维支气管镜 杓状软骨抬高的角度 

分 类 号：R445[医药卫生—影像医学与核医学] R614[医药卫生—诊断学]