不同充气量的食管引流型喉罩对于全麻患者机械通气的影响

Effect of different cuff inflation volume of Proseal Laryngeal Mask Airway on mechanical ventilation in patients under general anesthesia

目的研究不同充气量的食管引流型喉罩(PLMA)用于全麻患者机械通气时的囊内压及对患者通气功能的影响。方法40例ASAⅠ或Ⅱ级妇科及乳腺手术患者全麻下置入4号PLMA,在最大充气量30ml(MAX)、25ml(5/6MAX)、20ml(2/3MAX)、15ml(1/2MAX)、10ml(1/3MAX)、5ml(1/6MAX)和0充气量时监测囊内压并用旁气流通气监测法(SSS)监测患者的通气功能的变化,同时记录气道漏气情况。结果所有患者MAX的套囊内压都大于60cmH2O;气道密闭压(Pleak)随通气罩充气量减小而逐渐降低,而气道阻力(Raw)逐渐增大。在1/3MAX充气量以下的气道漏气发生率、动态胸肺顺应性(Compl)、1/6MAX以下的呼出潮气量(TVex)和呼出分钟通气量(MVex)与MAX时相比差异有统计学意义(P<0.05或P<0.01)。结论最适宜的充气方法为开始充气1/2MAX,如果气道压<15cmHO,喉罩周围有漏气,再增加5～10ml充气量。

Objective To observe the effect of different inflation volumes of ProSeal Laryngeal mask airway（PLMA） in patients under anesthesia. Methods Forty ASA class Ⅰ or Ⅱadult female patients undergoing elective surgery were studied. After standard intravenous anesthetic induction, insertion of PLMA with an introducer was performed. Pressure in cuff and respiratory mechanics with different inflation volumes of cuff were assessed. Results Pressures in cuff were always more than 60 cmH20 at the maximum inflation volume. Pleak was decreased and Raw was increased with the inflation volume of cuff decreased. Compared with the maximum inflation volume of cuff, the occurrence rate of gas leak from the airway and compliance at lower than 1/3 maximum inflation volume of cuff,TVex and MVex at lower than 1/6 maximum inflation volume of cuff. Conclusion The best cuff inflation volume is 1/2 MAX（15 ml）. If Paw less than 15 cmH20 or gas leak from airway exists,reinflating 5-10 ml gas is needed.