摘要
目的探讨无痛纤维支气管镜（纤支镜）检查专用喉罩用于无痛纤支镜检查的可行性和安全性。方法随机选择48例接受无痛纤支镜检查患者，男41例，女7例，年龄35～71岁，体重48-78kg，ASAI或Ⅱ级。随机数字表法均分为静脉麻醉组（A组）、静脉麻醉加喉罩组（B组）。两组均静注芬太尼1～2μg／kg、丙泊酚1．5～2mg／kg，A组保持自主呼吸，纤支镜由鼻孔进入操作；B组追加顺阿曲库铵0．1mg／kg后插入无痛纤支镜检查专用喉罩，控制呼吸，纤支镜从接头的螺旋帽插入进行操作。观察记录两组患者麻醉前（T0）、检查前即刻（T1）、纤支镜通过声门时（R）、纤支镜通过声门后3min（L）及检查结束即刻（L）时的MAP、HR、SpO2，记录两组患者的镜检条件及镜检时间，观察检查中的不良反应。结果与T0时比较，T1时两组MAP明显下降，HR明显减慢，A组Sp02明显升高（P〈0．05）；与T1时比较，T2～T4时A组SpO2明显降低（P〈0．05）；T2～T4时B组SpO2明显高于A组和T0时（P〈0．05）。B组镜检条件满意的为24例（100％），明显高于A组的18例（75％）（P〈0．05）。B组镜检时间（21．20±8．50）min，明显短于A组的（32．36±12．06）min（P〈0．01）。A组患者发生呛咳、呼吸抑制、喉痉挛、体动及鼻出血的发生率明显高于B组（P〈0．05）。结论无痛纤支镜检专用喉罩控制通气用于无痛纤维支气管镜检查，能有效控制患者的气道，显著改善镜检条件，是一项安全、可行的方法。
Objective To investigate the feasibility and safety of the dedicated laryngeal mask for painless fiber bronchoscopy. Methods Forty-eight outpatients and hospitalized patients, 41 males and 7 females, aged from 32-71 years old,weighted between 48-78 kg, and ASA I or Ⅱ , undergoing painless bronchoscopy were studied. Patients were randomly divided into two groups： Intravenous anesthesia group （group A） and intravenous anesthesia and laryngeal mask group （group B）. Both groups recieved intravenous fentanyl 1-2 μg/kg and propofol 1.5-2 mg/kg. In group A, Patients maintained spontaneous breathing and the bronchoscope was inserted into the airways through the nose. Patients in group B were given cis-atracurium 0. 1 mg/kg, followed by the insertion of the dedicated laryngeal mask, which controlled breathing. After that, the bronchoscope was inserted through the screw cap of the laryngeal mask. The MAP, HR and SpO2 in both groups were monitored thourghout the whole procedures in both groups. Their operation difficulty and adverse reactions during the examination were recorded as well. Results Patientsr HR in group A became higher when the bronchoscope passed through the glottis and SpO2 declined obviously. In contrast, HR did not change and SpO2 remained at a high level in group B. Compared to group A, the operation was easier, the whole procedure was shorter, and the incidence of adverse reactions was less in group B （P〈0.05）. Conclusion The dedicated laryngeal mask can effectively control breath and improve operation condition in the painless bronchoscopy. Thus it is a safe and feasible method for painless fiber-bronchoscope.
出处
《临床麻醉学杂志》
CAS
CSCD
北大核心
2013年第11期1070-1072,共3页
Journal of Clinical Anesthesiology
关键词
纤维支气管镜检
喉罩
专用喉罩
无痛
Fiber bronchoscopy
Laryngeal mask
Dedicated laryngeal mask
Painless
