全麻唤醒中声门外通气设备的系列研制

A series of externalglottis breath catheter for intraoperative wake-up

目的研制一种能讲话的声门外通气装置，以满足脑功能语言区手术中唤醒条件下监测、定位的需要，解决通气与讲话不能兼顾的难题。方法根据咽喉部解剖及通气和讲话原理研制成食道咽腔导管（I型）、食道鼻咽腔导管（Ⅱ型）和带吸引导管的食道鼻咽腔导管（III型）。临床应用60例，其中妇科全麻手术40例，术毕患者清醒于拔管前让患者讲话；脑部语言区手术全麻术中唤醒20例，唤醒后发音。结果60例患者插管顺利，术中通气良好，潮气量泄露〈56ml，均低于20cmH2O（1cmH2O=0．098kPa），血气正常，无二氧化碳蓄积及缺氧。患者清醒带管均能讲话，讲话的清晰度Ⅱ型和Ⅲ型导管显著优于I型（P〈0．01）。无严重并发症。结论I型、Ⅱ型和Ⅲ型导管，可安全实施全麻和机械通气，尤其是II型和Ⅲ型通气效果满意，讲话清晰，患者易耐受，显著地提高了脑功能语言区手术麻醉的安全性和可控性。解决了语言功能术中唤醒麻醉带管讲话的难题。

Objective To design a series of externalglottis breath catheters to solve the conflict between breath and sound production in wake-up patients during operation. Methods We have designed three model catheters, esophaguspharynx catheter （type I ）, esophagusnasopharynx catheter （type II ）, esophagusnasopharynx catheter with suction （type III ）. These catheters were applied to 60 patients who were implemented general anesthesia. 20 paitents were wake-uped during operation. Ruselts Intubation were successfully. All paitents had nice ventilation. Tidal volume leak was less than 56 ml, air passage pressure was under 20 cm H2O （1 cm H2O=0.098 kPa）, and blood gas analysises were normal. All patients had not found carbon dioxide cumulation nor anoxia. All paitents could speak with catheter, the pronounce articulation of type II and type III were better than type I （P〈0.01）. Conclusions Patient can speak distinctly with these catheter in operation. The series of catheters can provide nice ventilation, which are safety under mechanical ventilation and general anesthesia. Type II and type III are better. These catheters solved the conflict between breath and sound production in wake-up patients during operation in intraoperation wake-up, and can enhance the safety of brain operation.