摘要
目的探讨俯卧位下安全使用喉罩通气道进行全麻呼吸管理的方法。方法将49例俯卧位下胸、腰椎后路择期手术分为喉罩组(喉罩通气道,n=28)和经口插管组(气管插管,n=21)进行呼吸管理,比较插管(喉罩)前后、拔管(喉罩)即时循环改变以及体位改变对气道通气压力、气道密封压的影响;应用C臂机X线影像学技术比较体位改变对气管插管或喉罩通气道位置的影响。结果两组患者插管(喉罩)前、后血压、心率,组间比较无统计学差异(P>0.05)。经口插管组拔管后即刻血压高于喉罩组,有统计学差异(P<0.05);经口插管组面罩通气压力、插管后及俯卧位气道通气压力较喉罩组均明显升高,有统计学差异(均P<0.01);喉罩组俯卧位气道密封压较仰卧位时明显升高[(23.8±2.6)cm H_2O vs.(22.4±2.38)cm H_2O],有统计学差异(P<0.05)。C臂机X线显示:俯卧位后,喉罩罩杯上极下移,但是喉罩罩杯下极无明显位移;俯卧位后,气管导管末端向气管远端(气管隆凸)移位。结论俯卧位下使用喉罩通气,只要管理得当可能是一种安全有效的方法。
Objective To investigate the method of respiratory management for safe use of laryngeal mask airway anesthesia in prone position. Methods 49 patients undergoing posterior lumbar surgery in prone position were divided into laryngeal mask group(laryngeal mask airway, n=28) and the oral intubation group(endotracheal intubation, n=21), compared the changes of circulation before and after intubation or extubation immediately, observed the effect of body position on airway pressure and airway seal pressure; compared the effect of posture change on airway position of tracheal intubation or laryngeal mask airway by C arm X-ray imaging technique. Results There was no significant difference in blood pressure and heart rate before and after intubation(laryngeal mask airway) in two groups(P>0.05). The blood pressure of the oral intubation group was higher than that of the laryngeal mask group after extubation, and there was significant difference(P<0.05). The mask ventilation pressure, the ventilation pressure in supine position or prone position in oral intubation group were significantly increased than that in the laryngeal mask group, there was significant difference(P<0.05). Compared with the supine and prone position after two groups of patients with changes in airway pressure had no significant difference(P>0.05); In laryngeal mask group, the airway sealing pressure in prone position was increased significantly(23.8 cm H_2 O vs. 22.4 cm H_2O) than that in supine position, there was significant difference(P<0.05). C arm X-ray development showed: changed to the prone position, upper edge of laryngeal mask was going down, but lower edge of laryngeal mask was without obvious displacement; changed to the prone position, distal end of the tracheal catheter was going down to tracheal prominence. Conclusion Use of the laryngeal mask airway in prone position, as long as the proper management may be a safe and effective way.
出处
《中华临床医师杂志（电子版）》
CAS
2016年第19期2872-2876,共5页
Chinese Journal of Clinicians(Electronic Edition)
关键词
俯卧位
喉面罩
腰椎后路手术
Prone position
Laryngeal masks
Posterior lumbar surgery
