喉罩用于气管导管拔管后上呼吸道梗阻患者的气道急救

Availability of laryngeal mask in airway rescue for patients with upper airway obstruction after extubation

目的评价喉罩用于全身麻醉气管导管拔管后上呼吸道梗阻患者的气道急救效果,并筛选导致喉罩通气失败的危险因素。方法回顾统计第二军医大学附属长海医院2009年11月—2011年2月全身麻醉气管导管拔管后发生上呼吸道梗阻需置入喉罩进行急救的患者资料,记录患者的性别、年龄、体质指数、美国麻醉医师学会分级、术前肺部疾病史、手术类型、是否留置胃管、气道急救中丙泊酚用量、喉罩置入时间、喉罩置入时是否有吞咽和(或)呛咳反应、喉罩通气效果以及操作者使用喉罩的经验。如果喉罩通气失败,需重新置入气管导管者也予记录。记录人工气道建立成功后的血气分析结果、人工气道留置时间、患者是否转入重症监护病房(ICU)以及术后是否出现并发症和(或)死亡。采用Logistic回归分析筛选导致喉罩通气失败的危险因素。结果 78例在术后气管导管拔管出现上呼吸道梗阻的患者使用喉罩进行急救通气,喉罩通气有效率为78.2%(61/78)。与喉罩通气失败患者(重新气管插管)比较,喉罩通气成功患者的动脉血氧分压显著升高(P<0.05),人工气道留置时间显著缩短(P<0.05),ICU转入率显著降低(P<0.05)。Logistic回归分析显示,合并肺部疾病(OR=4.15,95%CI为1.18～8.37,P=0.027)和手术类型(上腹部手术,OR=2.18,95%CI为1.42～4.86,P=0.042)为导致喉罩通气失败的危险因素。结论喉罩可有效用于全身麻醉气管导管拔管后上呼吸道梗阻、面罩通气无效的患者。术前合并肺部疾病及上腹部手术可能导致此类患者喉罩通气失败。

Objective To evaluate the availability of laryngeal mask（LMA） in airway rescue when upper airway obstruction occurs after tracheal extubation and to determine the risk factors for failure in LMA ventilation. Methods The patients who developed upper airway obstruction after withdraw of endotracheal tube and needed to insert the LMA for ventilation from November 2009 to February 2011 were retrospectively analyzed.Gender,age,body mass index,American Society of Anesthesiologists（ASA） classification,preoperative respiratory diseases,operation types,presence of gastric tube,dose of propofol used in airway rescue,duration of LMA insertion,occurrence of swallowing and/or bucking,anesthesiologists＇ experience in using LMA,and the effectiveness of LMA ventilation were recorded.LMA was replaced by reintubation if LMA ventilation failed.The blood gas analysis,retention time of artificial airway,number of the patients transferred to Intensive Care Unit（ICU）,postoperative complications and mortality were noted when artificial airway was successfully established.Risk factors for failure in LMA ventilation were determined by Logistic regression analysis. Results Totally 78 patients were enrolled in this study.The successful rate of LMA ventilation was 78.2%（61/78）.Significant decrease in pressure of arterial oxygen,longer retention time of artificial airway and higher proportion of entering ICU were noted in the patients with reintubation（P0.05）.Preoperative respiratory disease（OR=4.15,95% CI=1.18-8.37,P=0.027） and upper abdominal surgery（OR=2.18,95%CI=1.42-4.86,P=0.042） were identified as risk factors for failure in LMA ventilation. Conclusion LMA is a valuable tool in airway rescue for patients with upper airway obstruction after tracheal extubation.However,preoperative respiratory disease and upper abdominal surgery may lead to failure in LMA ventilation.