能讲话的声门外通气装置——食道鼻咽腔导管的设计与应用

Supraglottic Ventilator Allowing Voice Communication:Esophageal Nasopharyngeal Catheter

目的：研制能讲话的声门外通气装置——食道鼻咽腔导管，并对其通气效果和患者使用时的讲话功能进行评价。方法：将6．5号气管导管的前端开口封闭，导管前端带套囊，相距8-10cm处上端带另一个套囊，两囊之间导管上开6个侧孔。导管经鼻至后鼻孔沿咽后壁前端进入食道，此时侧孔开口于喉咽腔内，上下两端气囊充气后可同时封闭食道、鼻咽腔和口咽腔。导管外口与麻醉机相接。气体经导管侧孔进入喉咽腔，只能经声门进入呼吸道形成密闭的呼吸回路而实现声门外通气。临床用于宫腹腔镜探查手术全麻20例，脑功能区手术6例，观察通气和讲话效果。结果：26例置管均顺利，一次到位，漏气量0。56mL，平均（26±10）mL，气道压12-25cmH2O，平均（16＋4）cmH2O，血气指标正常；讲话清晰、流利，可按指令回答各种问题。结论：食道鼻咽腔导管为一种新型带管能讲话的声门外通气装置。置管后能严密封闭食道、鼻咽腔和口咽腔，头颈活动基本不受影响，具有良好的通气效果。上端气囊放气后带管讲话吐词清晰、流利，能满足脑功能区术中唤醒、按指令发音讲话配合监测定位的需要。

Objective To study the esophageal nasopharyngeal catheter, a kind of supraglottie ventilator allowing voice communication, and evaluate its ventilation and communication. Methods The frontier opening of ID6.5 tracheal catheter was closed and equipped with a cuff, another cuff was located 8-10cm above the former, and there were 6 side holes be- tween the two cuffs. The catheter was introduced into the esophagus along the posterior pharyngeal wall through the posteri- or nares, when the side holes was towards the pharyngolaryngeal cavity and the external aperture was connected with the anesthesia machine with the esophagus, nasopharyngeal cavity and oropharyngeal cavity closed by the inflation of two cuffs. The air came into the pharyngolaryngeal cavity through the side holes, and then into the respiratory tract through the glottis to form a closed breathing circuit, finally the supraglottic ventilation was realized. The esophageal nasopharyngeal catheter was used in 20 cases of hysteroscopy laparoscopy explorations and 6 cases of brain areas surgeries, and the ventilation and voice communication during the operation were observed. Pesults Tube insertion was realized in one time for all the 26 cases, with 0-56 mL air leakage and the mean value of （26±10） mL, and 12-25 cmH2O airway pressure and the mean value of （16±4） cmH20. The blood gas indexes were in normal range and the voice communication was fluent. Conclnsion The esophageal nasopharyngeal catheter is a kind of supraglottic ventilator allowing voice communication, which can close the esophagus, nasopharyngeal cavity and oropharyngeal cavity strictly without any interference to the motion of the head and neck. With this catheter, intraoperative wake-up can be performed for brain areas surgery with the deflation of the upper cuff.[Chinese Medical Equipment Journal,2012,33（9）：28-30]