双管喉罩在放射性粒子植入治疗颌面部恶性肿瘤的应用

The use of LMA-ProSeal anesthesia in radioactive seed implantation treatment of maxillofacial malignancy

目的探讨第三代喉罩（proseal-laryngeal mask airway，PLMA）在颌面部放射性粒子植入治疗手术中的应用效果。方法放射性粒子植入治疗颌面部恶性肿瘤患者30例，美国麻醉医师（ASA）分级Ⅰ～Ⅲ级，年龄16—85岁，体重48—81公斤，男性10例，女性20例，粒子植入部位主要为腮腺、颌下区及颈部。常规给予芬太尼、异丙酚静脉麻醉诱导，患者下颌松弛后置入PLNA，术中保留自主呼吸，以2：1笑气和氧气，静脉靶控输注异丙酚和静脉持续输注瑞芬太尼维持。诱导后30分钟行动脉血气分析。观察喉罩置入成功率、置入成功后1、3、5min和拔除前后的血液动力学变化，术中患者脉搏氧饱和度（Sp02）变化，患者苏醒时间以及置入喉罩的并发症。结果所有喉罩均成功置入。喉罩置入后血压较基础值下降。诱导后30分钟血气呈一定程度高碳酸血症。4例患者术中出现异常气流声，但不影响通气；3例患者接受口腔前庭粒子植入，术中未发生喉罩移位和低氧血症。患者术后均苏醒迅速，8例患者诉口咽部轻度不适。结论双管喉罩在掌握一定适应证和谨慎观察下，能够有效、安全地应用于颌面部粒子植入手术。

Objective To evaluate the safety of using Proseal -laryngeal mask airway （PLMA） in radioactive seed implantation of maxillofacial malignancy. Methods Thirty patients with ASA Ⅰ～Ⅲ, 10 males, 20 females, aged 16 -85, weighed 48 ～ 81kg, underwent selected radioactive seed implantation of maxillofacial malignancy were studied. The main area received radioactive seed implantation was parotid, submandibulare and neck. The patients were anesthetically induced with fentanyl and propofol. PLMA were inserted when the jaw relaxed completely. Anesthesia was maintained with 50% Nitrous Oxide inhalation and intravenously Propofol and Remifentanil under spontaneous respiration. Blood gas was tested 30 minutes after induction. The successful ratio of inserting PLMA, the homodynamic change 1, 3, 5 minutes after insertion, before and after removing PLMA, the change of SpO2, the recover time and complications of PLMA, all were recorded. Results The successful ratio of inserting PLMA was 100%. Blood pressure after insertion was lower than basic value. The blood gas result of 30 minutes after induction showed hypercapnia to some degree. Four patients had air leakage in the pharynx, but ventilated well. Three patients received seed implantation in buccal cavity without position change of PLMA and hypoxemia during operation. All the patients recovered soon after operation. Eight patients complained mild discomfort in the pharynx. Conclusion The PLMA can be safely used in radioactive seed implantation of maxillofacial malignancy under proper indication and close observation.