全麻患者喉罩通气下平卧位和截石位的呼吸动力学比较赵晓黄施伟王.doc

全麻患者喉罩通气下平卧位和截石位的呼吸动力学比较 赵晓 黄施伟 王兆民 陈莲华 李士通 目的比较喉罩通气下平卧位与截石位手术患者呼吸动力学监测指标的差异，验证不同手术体位对喉罩通气效果的影响为临床上更合理使用喉罩通气，避免气道不良反应提供依据。方法选择全身麻醉择期手术患者例，年龄~65岁，美国麻醉医师学会(ASA) I～II级。根据手术体位分为平卧位（SPupine Position, n=30）截石位(LPithotomy Position, n=30)两组，分别记录术前、术中及拔除喉罩后的呼吸动力学监测指标吸气平台压（Pplateau）、平均气道压（Pmean）、呼气末正压（PEEP）、吸气峰流速 (FImax)、呼气峰流速(FEmax)、呼末二氧化碳分压（tCO2）诱导后15min测动脉血气：动脉二氧化碳分压（PaCO2）、 动脉氧分压（PaO2）同时记录血流动力学变化和不良发生情况。 结果组PIP、Pplateau、Ri、Re、WOB随手术时间延长逐渐增高，Cdyn、Cst降低，差异统计学（P0.05）P组诱导后5 min、10 min、15 min、30 minPIP、Pplateau数值于P组（P0.05）这些时间的FImax、FEmax、Cdyn、Cst于P组，差异统计学（P0.05）；。 结论：全麻普通型喉罩通气下，气道压力和气道阻力均随手术时间的延长而增加，其中截石位相对于平卧位气道压力和气道阻力的增加更为显著，且伴有胸-肺顺应性的。 关键词 机械通气喉罩平卧位截石位呼吸动力学 作者单位：200080 上海交通大学附属第一人民医院麻醉科 通讯作者：陈莲华，电子邮箱：chenlianhua1991@ The comparison of respiratory dynamics between lithotomy and supine position in patients general anesthesia with LMA ZHAO Xiao, HUANG Shi-wei, WANG Zhao-min, CHEN Lian-hua, LI Shi-tong Department of Anesthesiology, Shanghai First Peoples Hospital, Jiao Tong University, Shanghai, 200080, China Correspondence should be addressed to: CHEN Lian-hua, E-mail: chenlianhua1991@ Objective: Laryngeal mask airway (LMA) has been widely used in clinical anesthesia for the advantages over endotracheal intubation of easier insertion and milder cardiovascular response to insertion. Meanwhile, some drawbacks limit the application of LMA in controlled ventilation, such as air leakage and gastric air insufflations. The risk is supposed to be increased if the patient is undergoing some special surgical position. The study was designed to investigate the differences of respiratory dynamics between supine and lithotomy position in patients under general anesthesia with laryngeal mask airway (LMA), to determine the effectiveness of ventilation through LMA under the two surgical positions, and finally, to provide evidences for the proper usage of LMA with less airway adverse events. Methods: 60 cases of patients with ASA status I or II, aged 20~65, underwent selective surgeries in