弹性探条引导放置双管喉罩作用.docVIP

弹性探条引导放置双管喉罩作用 　　【摘要】 目的 本研究比较了双管喉罩(LMA-ProSealTM，PLMA)的三种插入方法:徒手置入法、工具置入法和弹性探条引导下置入法的成功率和并发症。方法 择期手术患者180例，ASAⅠ或Ⅱ级，随机分为3组，每组60例。Ⅰ组用徒手法，Ⅱ组用器械法，Ⅲ组用探条法。用纤维支气管镜观察PLMA的到位情况。记录拿起喉罩到插管成功到建立气道的时间以及插管次数。记录喉罩上有无染血。术后2 h随访，记录咽痛、发声、吞咽困难等并发症。结果 一次插管成功率分别为:徒手法85%，器械法88%，探条法100%。探条法的一次插管成功率较其他两组高(P0．05)；总的插管时间探条法的时间较短(PTM)的方法比徒手法和器械法更加可靠快捷。? 　　【关键词】喉罩；双管喉罩；弹性探条 　　?? 　　【Abstract】 Objective To compare three techniques for insertion of the ProSealTM laryngeal mask airway.Methods 180 patients,ASAⅠor Ⅱ,for selective surgery were randomized into three groups.There were 60 patients in each group.Patients in groupⅠwere digital technique,those in groupⅡusing introducer tool technique,those in group Ⅲ using gum elastic bougie-guided technique.The position of PLMA was examined by fiberoptic bronchoscopy.Anesthesia was induced,size 5 were used in male while size 4 were used in female patients.Insertion time and success attempts were recorded.Blood staining on LMA and sore throat,dysphagia,dysphonia 2 hours after surgery were recorded.Results Success ratio at the first attempt were digital,85%,IT 88%,GEB 100%.GEB guided technique success was more frequently than the other two groups; success after three attempts was similar:digital,95%,IT 97%,GEB 100%.There was no significant difference among general success after three attempts(P0．05).GEB guided technique showed less effective airway time.There was no difference for blood staining and sore throat among three groups(P0．05).Conclusion GEB guided technique is more reliable.? 　　【Key words】Laryngeal mask airway；ProSealTM laryngeal mask airway；Gum elastic bougie 　　 　　喉罩是一种声门上的通气装置，临床使用方便。双管喉罩(LMA-ProSealTM，PLMA)于2000年开始在临床应用，由于它有双气囊，改进了密闭性，更加适合正压通气；而且可以放置胃管，大大减少了胃胀、反流和误吸，安全性比普通喉罩明显??高，并在许多情况下可替代气管内插管。由于双管喉罩PLMA的罩体比较软，它的插管比普通喉罩相对困难。PLMA目前有3种插入方法:①徒手置入法；②使用置入工具置入法；③使用喉镜在弹性探条引导下置入法。徒手插入法和器械法第一次插管的平均成功率分别为84%(81%~100%)、95%(90%~100%)，比普通喉罩稍低(91%)。尽管徒手插入法和器械法的一次成功率不低，但是使用弹性探条能否进一步提高成功率，仍有待研究。本文拟比较弹性探条引导下置入法是否优于徒手插入法和器械法。? 　　1 资料和方法? 　　1．1 一般资料