Proseal喉罩在全身麻醉中的应用

The application of Proseal laryngeal mask airway in general anesthesia

目的 观察Proseal喉罩在全身麻醉中的安全性、可行性.方法 择期全麻手术病人40例,年龄18～65岁,ASAⅠ～Ⅱ级,随机分为喉罩组(PLMA组,20例)和气管插管组(TT组,20例).用纤维支气管镜观察PLMA的到位情况.记录患者心率(HR)、平均动脉压(MAP)、气道峰压(Pmax)、气道平均压(Pmean)、潮气量(VT)、分钟通气量(MV)、脉搏血氧饱和度(SPO2)、呼气末二氧化碳分压(PETCO2)的变化数值及相关并发症.结果 ①血液动力学的变化:PLMA组在置入期和拔除期平均动脉压、心率的变化较TT组小(P＜0.05).②通气效果:两组的Pmax、 Pmean 、VT、MV、 PETCO2数值随麻醉手术影响变化一致,组间比较无显著性差异(P＞0.05).③并发症:PLMA组并发症例数少于TT组,苏醒期躁动、术后声嘶、咽喉不适发生率明显少于TT组(P＜0.05).结论 与气管导管相比较 ,Proseal喉罩用于全麻手术操作简便,应激反应小,通气满意,且咽喉部并发症少,安全可靠.

Objective To observe the safety and efficacy of LAM-Proseal used in general anesthesia.Methods Forty elective operation patients under general anesthesia of both sexes aged 18-65yr (ASAⅠ～Ⅱ) were randomized to either laryngeal mask airway group (PLMA,n=20)or tracheal intubation group (TT,n=20). The optimal position of PLMA was confirmed by fiberoptic bronchoscopy. Heart rate (HR), mean blood pressure (MAP), peak airway pressure (Pmax), mean airway pressure (Pmean), tidal volume (VT), minute ventilation (MV), oxygen saturation measured by pulse oximeter (SPO2), end expiratory carbon dioxide pressure (PETCO2) and laryngeal mask intracuff pressure (Pcuff) were monitored.Results Changes in HR and MBP after insertion and before extubation were less in PLMA group as compared with TT group (P<0.05). There were no significant differences in Pmax , Pmean, VT, MV, SPO2, PETCO2 at all time points between the two groups (P>0.05). Complication incidence was significantly lower in PLMA group than that in TT group, including sore throat and hoarseness of the voice(P<0.05).Conclusion PLMA is safe and reliable, it is superior to endotracheal intubation in terms of ease of manipulation, favourable ventilation, less stress reaction and laryngopharyngeal complications.