双管喉罩与食管气管联合导管在困难气道应用中的对比研究

Contrast research of proseal laryngeal mask airway and esophageal tracheal combitube used in difficult airway patients

目的比较围手术期成年患者双管喉罩（PLMA）与食管气管联合导管（ETC）在困难气道应用中的临床效果。方法选择困难气道的成年患者40例，ASA分级Ⅰ～Ⅱ级，按机械抽样法随机分为PLMA组和ETC组，每组各20例，常规麻醉诱导后，分别置入PLMA或ETC。分别观察记录插管次数、插管时间、手术时间，以及置入前（T1）、置入即刻（T2）、置入后1min（T3）、置人后5min（T4）、置入后10min（T5）、拔管即刻（T6）的收缩压、舒张压、心率。同时记录患者的并发症和呼吸道损伤情况。结果两组均首次置入即获得满意肺通气。T2、T3、T6时收缩压、舒张压、心率，ETC组[T2：（143．2±11．4）mmHg（1mmHg=0．133kPa）、（86．9±10．7）mmHg、（145．8±10．2）次／min，T3：（140．0±11．3）mmHg、（84．5±10．7）mmHg、（142．5±11．5）次／min，T6：（147．7±11．3）mmHg、（87．2±9．7）mmHg、（145．4±10．9）次／min]显著高于PLMA组[T2：（123．5±12．7）mmHg、（72．6±11．4）mmHg、（129．0±11．0）次／min，T3：（120．0±11．5）mmHg、（69．7±10．5）mmHg、（125．7±10．6）次／min，T6：（122．5±11．6）mmHg、（71．4±9．4）mmHg、（127．8±11．3）次／min]及T1[（122．7±12．1）mmHg、（74．1±9．6）mmHg、（121．0±11．8）次／min]（P〈0．05）。两组并发症和呼吸道损伤情况比较，差异均无统计学意义（P〉0．05）。结论PLMA和ETC用于围手术期困难气道的成年患者均可获得满意的肺通气，是围手术期困难气道患者安全有效的呼吸道管理工具，但PLMA应激反应轻微，血流动力学更稳定。

Objective To compare the effect of proseal laryngeal mask airway （PLMA） and esophageal tracheal combitube （ETC） used in adult patients of difficult airway in perinperation. Methods Forty ASA Ⅰ - Ⅱ adult patients of difficult airway were randomly divided into two groups ： PLMA group and ETC group, each group was 20 cases. After intravenous anesthesia induction, PLMA or ETC was inserted by routine methods. The number of intubation, intubation time and time to surgery were recorded. The systolic blood pressure （SBP）, diastolic blood pressure （DBP） and heart rate （HR） were recorded before intubation （T1）, during after intubation （T2）, at 1 min （T3）, 5 min （T4）, 10 min （Ts） after intnbation, during extubation （T6）. The intubation, the extubation and the maintain ventilation process of the respiratory complications and respiratory damage were recorded. Results All patients in PLMA group and ETC group achieved satisfactory lung ventilation at the first attempt. The number of intubation, intubation time and time to surgery were not different between the two groups （P〉 0.05）. SBP, DBP, HR at T2, T3, Ts in ETC group [T2： （ 143.2 ± 11.4） mm Hg （ 1 mm Hg = 0.133 kPa）, （86.9 ± 10.7） mm Hg, （ 145.8 ±10.2） times/min,T3： （140.0 ± 11.3） mm Hg, （84.5 ± 10.7） mm Hg, （142.5 ± 11.5） times/min,T6：（147.7 ± ll.3）mm Hg, （87.2 ± 9.7）mm Hg, （145.4 ± 10.9） times/mini were significantly higher than those in PLMA group [T2： （123.5 ± 12.7）mm Hg, （72.6 ± 11.4） mm Hg, （129.0 ± ll.0）times/min,T3：（120.0 ±11.5） mm Hg, （69.7 ± 10.5） mm Hg, （125.7 ± 10.6）times/min,T6：（122.5 ± 11.6） mm Hg, （71.4 ±9.4） mm Hg, （ 127.8 ± 11.3 ） times/min ] and at T, in ETC group [ （ 122.7 ± 12.1 ） mm Hg, （74.1 ± 9.6） mm Hg, （ 121.0 ± 11.8 ） times/min ] （P 〈 0.05 ）. Respiratory complications and damage were no significant difference between the two groups （P 〉 0.05 ）. Conclusion PLMA and ETC can achieve satisfactory lung ventilation used in adult patients of difficult airway in perioperation, they are safe and effective airway management device, but PLMA used in adult patients of difficult airway in perioperation is better than ETC in keeping stable hemodynamics and producing less stress responses.