喉罩咽喉内不同旋转角度对气道密封压影响.docVIP

喉罩咽喉内不同旋转角度对气道密封压影响 　　[摘要] 目的 评价超声下喉罩咽喉内不同旋转度对气道密封压的影响。方法 择期全身麻醉下妇科手术患者128例，ASA分级Ⅰ～Ⅱ级。第一位麻醉医生麻醉诱导后插入一次性使用喉罩气道导管行机械正压通气并记录气道峰压（peak inspiratory pressure，PIP）。超声医生使用颈部超声（USG）通过食道甲状腺横切面观察喉罩旋转度进行评估并记录，第二位麻醉医生使用纤维支气管镜（fiberoptic bronchoscope，FOB）确认喉罩位置，第三位麻醉医生记录口咽漏气压（OLP）。结果 与轻度旋转比较，中度和重度旋转时高OLP患者例数减少（P0.05）。 结论 超声提示喉罩轻度旋转时患者的OLP明显提高，喉罩的密闭性较好，满足手术要求。 　　[关键词] 超声检查；喉罩； 口咽漏气压 　　[中图分类号] R614 [文献标识码] B [文章编号] 1673-9701（2014）22-0053-03 　　[Abstract] Objective To evaluate the influence of different rotation angles of laryngeal mask in throat on the airway sealing pressure under ultrasound. Methods 128 patients with ASA grade I to II， who had received gynecological surgery under general anesthesia were selected. The first anesthetist conducted mechanical positive pressure ventilation by inserting disposable laryngeal mask airway catheter after anesthesia induction and record peak inspiratory pressure （PIP）.The ultrasound doctor observed the laryngeal mask rotation degree through esophagus thyroid transaction under ultrasonography（USG） and record；The second anesthetist confirmed the location of laryngeal mask using fiberoptic bronchoscope（FOB）；The third anesthetist recorded oropharyngeal leak pressure（OLP）. Results Compared to slight rotation，the case numbers of high OLP patients of moderate and severe rotation were smaller（P0.05）； Compared to moderate rotation， the case number of high OLP patients of severe rotation was smaller（P0.05）. The differences in fiber bronchoscope grade and peak inspiratory pressure between different rotation locations were not statistically significant（P0.05）. Conclusion Ultrasound suggests that the patients’ OLP of mild laryngeal mask rotation improves significantly.The leakproofnes of laryngeal mask is good and meets the surgical requirements. 　　[Key words] Ultrasound examination； Laryngeal mask； Oropharyngeal leak pressure 　　喉部的密闭性决定了喉罩气道的密闭性，良好的喉密闭性可减少漏气导致的胃胀气等不适，并保证足够的肺部通气。临床上主要通过听诊肺部、挤压贮气囊时通气阻力大小来判断喉罩位置[1]，但并不能简单的通过听诊胸部和监测呼吸参数来判断喉部的密闭性是否良好，