改良喉罩控制通气在全身麻醉电子支气管镜操作中的应用

Application of the modified laryngeal mask airway to controlled ventilation for patients undergoing electronic bronchoscopy under general anesthesia

目的:探讨改良喉罩控制通气在全身麻醉电子支气管镜检查及介入治疗中的应用价值。方法:实施电子支气管镜检查及介入治疗的患者共15例,在快速诱导全身麻醉下置入改良喉罩,连接麻醉机实施控制通气,置入电子支气管镜实施检查及介入治疗。记录麻醉诱导前(T0)、插入喉罩控制通气后(T1)、手术中(T2)、手术后(T3)不同时间点收缩压(SBP)、心率(HR)、经皮氧饱和度(SpO2)及呼气末二氧化碳分压(PETCO2)的变化。结果:15例患者全身麻醉控制通气后虽然SBP、HR有所下降,SpO2、PETCO2升高,差异具有统计学意义,但患者术中、术后生命体征稳定,无严重并发症发生;T1与T0比较SBP、HR下降(P<0.01),SpO2升高(P<0.01),差异具有统计学意义;T2与T0比较SBP、HR下降(P<0.01),SpO2升高(P<0.05),差异具有统计学意义;T3与T1比较SBP、HR、SpO2(P>0.05)差异无显著性;T2与T1比较,PETCO2升高(P<0.01),差异具有统计学意义;T3与T1比较PETCO2(P>0.05)差异无统计学意义。结论:经改良喉罩控制通气在全身麻醉下行电子支气镜检查及介入治疗,生命体征稳定,避免了低氧血症的发生,具有临床应用价值。

Objective：To assess the clinical value of applying the modified laryngeal mask airway（LMA） to controlled ventilation for patients undergoing electronic bronchoscopy and intervention therapy under general anesthesia.Methods：By rapid sequence induction of the general anesthesia,15 patients undergoing electronic bronchoscopy and interventional therapy were managed with the modified LMA that was joined to the anesthesia apparatus,and monitored for the variations of systolic blood pressure（SBP）,heart rate（HR）,SpO2 and PETCO2 before anesthesia induction（T0）,after placement of LMA for controlled ventilation（T1）,in-operation（T2） and post-operation（T3）.Results：Although dropped SBP and HR were seen in the 15 patients,yet,SpO2 and PETCO2 were found elevated.The vital signs were stable for all patients,and no serious complications occurred during the procedure.SBP and HR were dropped,whereas SpO2 was elevated as compared between the time point of T1 and T0（P〈0.01） or T2 and T0（P〈0.05）.No significant difference was seen between T3 and T1 concerning SBP,HR and SpO2（P〉0.05）.PETCO2 was risen by comparison with T2 and T1（P〈0.01）,yet,it had no statistical difference between T3 and T1（P〉0.05）.Conclusion：Modified LMA has clinical value for patients undergoing electronic bronchoscopy and interventional therapy under general anesthesia,for it can make stable vital signs and avoidance of hypoxemia during the procedure.