自制连接管联合改良喉罩通气在纤维支气管镜诊治中的应用

Self-made Connecting Tube Combined with Modified Laryngeal Mask Airway in Fiberoptic Bronchoscopy

目的探讨自制连接管联合改良喉罩通气在纤维支气管镜（纤支镜）检查和治疗中的应用效果。方法 52例需行纤支镜诊治的患者,其中单纯纤支镜检查20例,纤支镜肺活检15例,纤支镜下高频电刀支气管肿瘤切除13例,纤支镜肺泡冲洗4例。依次缓慢静脉注射长托宁1 mg、芬太尼3μg/kg,异丙酚2 mg/kg,爱可松0.2 mg/kg,快速诱导麻醉下插入改良喉罩,通过自制连接管接呼吸机控制呼吸。麻醉维持持续静脉泵注异丙酚4-6 mg·kg^-1·h^-1,瑞芬太尼0.1μg·kg^-1·h^-1。纤支镜检查时,纤支镜充分润滑后伸入自制连接管的橡皮孔,通过改良喉罩顺利进入气管、支气管,进行检查和治疗。记录患者麻醉前5 m in（T0）、插入喉罩即刻（T1）、机械通气5 m in（T2）、纤支镜检查开始时（T3）、纤支镜检查5 m in（T4）、手术结束时（T5）收缩压（SBP）、舒张压（DBP）、心率（HR）、血氧饱和度（SPO2）,气道峰压（Ppeak）及各时点呼吸末二氧化碳分压（PE tCO2）,患者完全清醒后询问是否有咽痛及对检查过程的满意度。结果置入喉罩进行机械通气后（T2）SPO2较T0时明显升高,纤支镜检查过程中（T3、T4）SPO2较T1、T2无明显变化,镜检中（T1-T5）SBP、DBP、HR组内比较差异无统计学意义,纤支镜进入气道后（T3、T4）Ppeak较T2明显增加,差异有统计学意义（P〈0.05）,但T2、T3、T4时Ppeak都在参考范围内,PE tCO2无明显变化。纤支镜检查和治疗顺利,患者苏醒后未诉咽痛,对经喉罩通气下行纤支镜检查和治疗的满意度为100%。结论自制连接管联合改良喉罩通气应用于纤支镜检查和治疗,成功解决了检查和麻醉共用一个通道、呼吸管理困难的难题,这种方法对设备的要求不高,而且安全舒适,有很强的安全性和可行性。

Objective To investigate the application of self-made connecting tube combined with modified laryngeal mask airway in fiberoptic bronchoscopy（FB）.Methods Fifty-two patients needed FB,including 20 needing simple FB,15 FB lung biopsy,13 high-frequency electric knife bronchial tumor resection under FB,4 needing FB lavage.Patients were injected intravenously with penehyclidine hydrochloride（1 mg）,fentanyl（3 μg/kg）,propofol（2 mg/kg）,rocuronium（0.2 mg/kg）,and modified laryngeal mask inserted under rapid induction of anesthesia and self-made connecting tube connected to ventilator to control breath.Anesthesia was maintained by continuous intravenous infusion of propofol 4~6 mg·kg^-1·h^-1,remifentanil0.1 μg·kg^-1·h^-1.Bronchoscope was inserted into self-made connecting tube after fully lubrication and smoothly into trachea and bronchus through modified laryngeal mask to perform examinations and treatments.Systolic pressure（SBP）,diastolic pressure（DBP）,heart rate（HR）,SPO2,peak airway pressure（Ppeak） and PEtCO2 were recorded at 5 min before anesthesia（T0）,at the very moment of laryngeal mask insertion（T1）,at 5 min after mechanical ventilation（T2）,at starting time of FB（T3）,at 5 min after FB（T4）,at end of operation（T5）.Patients were asked whether they had pharyngalgia and their satisfaction.Results SPO2 was significantly higher at T2 than at T0,but there was not significant difference between at T3,T4 and T1,T2;there was not significant difference in SBP,DBP,HR between all groups;Ppeak increased at T3,T4 as compared with at T2,but within normal range;PEtCO2 had no remarkable changes.FB and treatment went smoothly.Patients did not complained about pharyngalgia and their satisfaction was 100%.Conclusion Self-made connecting tube combined with modified laryngeal mask airway in FB has solved successfully the problem of breathing management difficulties due to inspection and anesthesia sharing a common channel.Its equipment demand is not high,but it is safe and feasible enough.