三通喉罩通气在纤支镜肺部急诊止血中的应用

APPLICATION OF THREE-WAY LARYNGEAL MASK AIRWAY VENTILATION IN BRONCHOFIBERSCOPE HEMOSTASIS IN LUNGS

目的：探讨三通喉罩（three-way laryngeal mask airway,TLMA）纤维支气管镜在肺部急诊止血中的应用及其安全性。方法：15例患者,在快速诱导全身麻醉下插入TLMA,TLMA的标准端口连接麻醉机进行控制通气,从TLMA内镜入口置入纤维支气管镜,经声门进入气管、支气管,实施肺部止血术。记录麻醉前5min时（T0）,插入TLMA后即刻（T1）,通气1min时（T2）,通气5min时（T3）,通气10min时（T4）,通气20min时（T5）,通气30min时（T6）,手术结束时（T7）的收缩压（SBP）、舒张压（DBP）、心率（HR）、脉搏氧饱和度（SpO2）;记录患者通气T1、T2、T3、T4、T5、T6、T7的潮气量（VT）、气道峰压（Ppeak）及呼气末二氧化碳分压（PETCO2）;测定T0、T3、T5、T7时间点的血气分析。记录麻醉和手术的效果和过程。结果：全部15例手术顺利完成,手术时间20-38min,通气时间30-45min。与T0时比较,其余时点SBP、DBP、HR、VT、Ppeak和PETCO2差异无统计学意义（P〉0.05）,T2-7时SpO2明显升高（P〈0.05）。血气分析结果显示：三通喉罩通气后二氧化碳分压（PCO2）、氧分压（PO2）和血氧饱和度（O2sat）明显改善（P〈0.05）。均于术后30min内清醒并拔除喉罩。结论：TLMA用于支气管镜肺部止血安全、可靠、效果满意、并发症少。

Objective：To study the efficacy and safety of three-way laryngeal mask airway（TLMA）ventilation in bronchofiberscope hemostasis in lungs.Methods：Fifteen patients aged from 12 to 83 years and admitted for tracheal intubation with TLMA under general anesthesia in bronchofiberscope hemostasis in lungs.SBP,DBP,HR and SpO2 were measured at 5 min after entering the surgery（T0）,immediately after inserting TLMA（T1）,1 min（T2）,5 min（T3）,10 min（T4）,20 min（T5）and 30 min（T6）after mechanical ventilation,and immediately end of operatoin（T7）.Peak inspiratory airway presure（Ppeak）,tidal volume（VT）and expiratory CO2 presure（PETCO2）were recorded at T2,T3,T4,T5,T6,T7.Blood specimens were taken at T0,T3,T5,T7 for blood gas analysis.Effects of anesthesia and operation were recorded.Results：All of the operations were successful,satisfactory effects were observed in the 15 cases.The operation time was 20~38 min and the ventilation time 30~45 min.As compared with T0,there was no significant difference in SBP,DBP,HR,VT,Ppeak and PETCO2 at T1-7（P〉0.05）,but SpO2 was significantly increased at T2-7（P〈0.05）.The results of blood gas analysis showed that PCO2,PO2 and O2sat were obviously improved after TLMA ventilation（P〈0.05）.The patients awoke in 30 min and the TLMA was removed.No side effect and complications were observed in all cases.Conclusion：TLMA for bronchofiberscope hemostasis in lungs is a effency and safe method without any complications.