SLIPA喉罩在全麻气道管理中的应用

Application of streamline liner of pharyngeal airway in airway management of general anesthesia

目的 探讨SLIPA喉罩在全麻气道管理中的有效性.方法 择期全麻下行乳腺肿物切除术的女性患者60例,ASA分级Ⅰ～Ⅱ级,电脑排位随机分为SLIPA喉罩组（S组）和普通喉罩组（L组）,每组各30例.诱导用药为普鲁泊福2mg/kg、舒芬太尼0.15μg/kg和维库溴铵0.08mg/kg,维持用药为50%氧化亚氮-50%氧气和1%～29%七氟烷,麻醉机参数设置相同.两组患者均根据体重选择喉罩型号,采用徒手法置入.记录喉罩置入次数、气道密封压、纤维支气管镜检查声带显露评分;记录喉罩置入成功后每隔15 min的脉搏血氧饱和度（SpO2）、呼气末二氧化碳分压（PERCO2）、气道峰压;观察拔出喉罩后咽喉痛、反流误吸发生情况;记录手术时间、麻醉时间、拔喉罩时间、苏醒时间.结果 两组喉罩置入成功率均为100%,S组1次置入成功率（90%,27/30）明显高于L组（60%,18/30）（P〈0.05）;S组纤维支气管镜检查声带显露评分为4分者（20例）多于L组（11例）（P〈0.05）;S组气道密封压为（23.6±4.7）cm H2O（1 cm H2O=0.098 kPa）,L组为（18.8±4.5）cm H2O,两组比较差异有统计学意义（P〈0.05）.置入喉罩后两组所观察的各时段的SpO2、PErCO2、气道峰压均在正常范围内.拔出喉罩后咽喉痛S组7例,L组6例,两组均无反流误吸情况发生.结论 SLIPA喉罩操作简单易行,密封效果好,能有效地进行正压通气,不良反应少,能安全有效地用于全麻气道管理.

Objective To evaluate the efficacy of streamline liner of pharyngeal airway （ SLIPA） in airway management of general anesthesia. Methods Sixty ASA Ⅰ -Ⅱ patients undergoing elective breast surgery were randomized into 2 groups （30 cases each）： SLIPA group （group S） and laryngeal mask airway （LMA） classic group （group L）. Anesthesia was induced with propofol 2 mg/kg, sufentanil 0.15 μ g/kg and vecurium 0.08 mg/kg. SLIPA or LMA was inserted with digital manipulation. Anesthesia was maintained with 1% - 2% sevofluran and 50% N2O in 50% oxygen. The parameters of controlled ventilation were same in both groups. The attempt times, seal pressure and grade of fiberoptic （FOB ） laryngoscopy were measured. SpO2, PErCO2 and peak airway pressure were monitored every 15 minutes after successful laryngeal mask insertion. The complications such as regurgitation of gastric contents and sore throat were assessed by anesthesiologist after surgery. Surgery time, anesthesia time, extubation time and emergence time were recorded. Results Success rate of LMA insertion in both groups were 100%. The first attempt success rates were 90%（ 27/30） in group S and 60%（ 18/30） in group L （P〈 0.05）, the FOB grade 4 were 67%（20/30） in group S and 37% （ll/30）in group L（P〈 0.05）, the maximum seal pressures were （23.6 ± 4.7）cmH2O （1 cm H2O = 0.098 kPa） in group S and （18.8 ± 4.5） cm H2O in group L （P〈0.05）. SpO2, PErCO2 and peak airway pressure were within normal ranges. The occurrence of sore throat was similar in group S and group L （7 cases vs 6 cases）. No signs of regurgitation were detected. Conclusion The SLIPA proved to be a simple, safe and effective airway instrument with little complications during the course of general anesthesia.