第四代喉罩用于全麻的通气效果观察

凌刚　吴雪　徐辉翔　刘国栋　卢军杰　李斌

【摘要】 目的：探討第四代喉罩用于全麻对血气结果和呼吸指标的影响。方法：选择ASAⅠ～Ⅲ级全麻患者100例，随机分为喉罩全麻组（LMA组）和气管插管全麻组（TT组），每组50例，采集动脉血进行血气分析，检测插管后2 min（T1）、拔管后2 min（T2）动脉血pH值、氧分压（PaO2）、二氧化碳分压（PaCO2）、血氧饱和度（SaO2）、乳酸（Lac）值，记录插管后即刻（T3）、插管后5 min（T4）、切皮（T5）、术中探查（T6）、缝皮（T7）、拔管前即刻（T8）潮气量（Vt）、气道平台压（Pplat）、气道峰压（Ppeak），观察拔管反应及24 h咽喉部并发症发生情况。结果：LMA组T1时PaO2高于TT组，Lac水平低于对照组，差异均有统计学意义（P<0.05），两组T2时PaO2、Lac水平及各时间点时pH值、PaCO2、SaO2比较差异无统计学意义（P>0.05）。LMA组T8时Pplat及Ppeak均低于TT组，差异均有统计学意义（P<0.05），两组其他时点Pplat、Ppeak和各时点Vt比较差异无统计学意义（P>0.05）。LMA组拔管时呛咳和体动发生率均低于TT组，差异均有统计学意义（P<0.05），两组咽喉部并发症发生率比较差异无统计学意义（P>0.05）。结论：第四代喉罩用于全麻通气效果良好，可改善血气和呼吸指标，并发症少。

【关键词】 喉罩 全麻 血气 呼吸

doi：10.14033/j.cnki.cfmr.2020.21.062 文献标识码 B 文章编号 1674-6805（2020）21-0-04

Effects of the Fourth Generation Laryngeal Mask Airway on Blood Gas and Respiratory Indicator Undergoing General Anesthesia/LING Gang， WU Xue， XU Huixiang， LIU Guodong， LU Junjie， LI Bin. //Chinese and Foreign Medical Research， 2020， 18（21）： -153

[Abstract] Objective： To observe the effects of the fourth generation laryngeal mask airway on blood gas and respiratory indicator undergoing general anesthesia ventilation. Method： A total of 100 ASA Ⅰ-Ⅲ patients undergoing general anesthesia were randomly divided into the laryngeal mask airway group （LMA group） and the tracheal intubation group （TT group）， with 50 cases in each group. Arterial blood was collected for blood gas analysis. Blood pH， PaO2， PaCO2， SaO2 and Lac were detected at 2 minutes after intubation （T1） and before extubation （T2）. Tidal volume （Vt）， platform airway pressure （Pplat） and peak airway pressure （Ppeak） were recorded immediately after intubation （T3）， 5 minutes after intubation （T4）， skin incision （T5）， intraoperative exploration （T6）， suture skin （T7） and immediately before extubation （T8）. Extubation reaction and laryngopharyngeal complications in 24 h after operation were recorded. Result： At T1， PaO2 in the LMA group was higher than that in the TT group， and Lac level was lower than that in the control group， the differences were statistically significant （P<0.05）. There were no statistically significant differences in PaO2， Lac level at T2 and pH value， PaCO2 and SaO2 at each point between the two groups （P>0.05）. At T8， Pplat and pH value， PaCO2 and SaO2 at each time point and Ppeak in the LMA group were lower than those in the TT group， the differences were statistically significant （P<0.05）. There were no statistically significant differences in Pplat， Ppeak at other time points and Vt at each time point in the two groups （P>0.05）. The incidence of cough and body movement during extubation in the LMA group was lower than that in the TT group， the difference was statistically significant （P<0.05）， there was no significant difference in the incidence of pharyngeal complications between the two groups （P>0.05）. Conclusion： The fourth generation laryngeal mask airway is goodfor general anesthesia ventilation. It can improve blood gas and respiratory indicator with little complications.

[Key words] Laryngeal mask airway General anesthesia Blood gas Respiration

First-authors address： Pingli County Hospital， Pingli 725500， China

气管导管是在全麻中维持正常呼吸功能的经典气道管理工具之一，安全性和可行性很高，具有其他工具无法替代的优越性。第四代喉罩是一种新型的多功能双腔喉罩，兼有插管型喉罩和食管引流型喉罩的特点，具有放置简单快速、无须喉镜暴露声门、不损伤声带和气管、应激反应轻、耐受性良好、固定方便等优点[1-3]。作为一种不稳定气道，喉罩不插入气管内，套囊密封的可靠性和气道的维护性不如气管导管强，移位现象时有发生，且不能耐受气道高压，在气道平台压增高的情况下常发生漏气，因此可能导致通气不足和二氧化碳蓄积[4]。……