经三通喉罩通气在支气管镜肺部急症治疗中的价值

The Value of Three-way Laryngeal Mask Airway Ventilation in Transbronchial Treatment of Lung Emergency Cases

目的:评价经三通喉罩(three-way laryngeal mask airway,TLMA)通气在全身麻醉下支气管镜肺部急症治疗中的价值。方法:实施气管异物取出术或支气管肺灌洗术的患者,在快速诱导全身麻醉下应用TLMA通气,记录患者麻醉前5min时(T0),插管后即刻(T1)、插管后3min(T2)、通气5min时(T3)、通气10min时(T4)、通气20min时(T5)、拔管时(T6)的收缩压(SBP)、舒张压(DBP)、心率(HR)和脉搏氧饱和度(SpO2),记录T1,T2,T3,T4,T5,T6时的潮气量(VT)、气道峰压(Ppeak)及呼气末二氧化碳分压(PETCO2);于T0、T2、T4、T6时间点采集动脉血做血气分析,观察麻醉、手术效果和过程。结果:全部病例手术顺利完成,TLMA通气不同时点血流动力学指标稳定,通气效果良好,无明显并发症。结论:TLMA用于支气管镜肺病急症治疗中的通气安全可靠、效果满意、并发症少。

Objective： To evaluate the use of the three-way laryngeal mask airway （TLMA） ventilation in treatment of pulmonary emergency cases via fiberoptic bronchoscope. Methods： TLMA ventilation was carried out on 25 patients aged 3.5 - 65 yeas, admitted for tracheal intubation under quick general anesthesia for bronchial foreign body removal or bronchoalveolar lavage. Systolic blood pressure （SBP）, diastolic blood pressure （DBP）, heart rate （HR）, and pulse oxygen saturation （SpO2） were measured at 5 rain before the anesthesia（T0） , immediately after intubation（ T1 ）, 3 min after intubation（T2）, 5 min （T3）, 10 min （T4）, and 20 min （T5） of ventilation,and immediately after extubating（T6）. Peak inspiratory airway pressure （Ppeak）, tidal volume （VT） and PETCO2 were recorded at T1,T2 ,T3, T4, T5 and T6. Blood specimens were taken at T0, T2, T4 and T6 for blood gas analysis. Process of anesthesia and operation were recorded. Results： All the operations were successful, and satisfactory effects were observed in the 25 cases under study. No side effect or complication was observed in all cases. Conclusion ： The application of TLMA ventilation in treatment of lung emergency cases is safe, with satisfactory results and less complication, and has values of generalization.