医疗救援中喉罩通气的可行性研究

Feasibility of laryngeal mask airway ventilation in mechanical rescue

目的分析喉罩的可操作性、安全性、通气参数及并发症，探讨其在灾害医疗救援中应用的可行性。方法随机选择的择期全麻手术患者100例，随机均分为2组：初次使用组（A）和熟练使用组（B），分别由初次使用（使用喉罩10～20例）和熟练掌握（超过100例）喉罩的医生各10人放置喉罩。麻醉诱导待脑电双频指数值达到50时放置喉罩，位置满意后，接呼吸机控制呼吸，并根据潮气末二氧化碳（PETCO2）结果调整呼吸频率、潮气量，维持气道峰压（Ppeak）10-30cmH2O，PETCO233-55mmHg，血氧饱和度（SpO2）≥96％。记录喉罩放置难易程度、安全性、气道最大密封压、通气相关参数和并发症。结果两组患者均顺利完成机械通气，喉罩插入操作的难易程度和安全性无统计学差异（均P〉0．05）。两组患者Ppeak在B和T4时明显高于B（均P〈0．05），其余各参数两组间差异无统计学意义（均P〉0．05）。A、B组患者术后主诉咽喉轻度不适分别为4例和2例；A组有1例患者术后胃胀气；两组患者均未发生术中知晓。结论喉罩可操作性强、安全有效，具有良好的气道耐受性和舒适性，可考虑在医疗救援中应用。

Objective To investigate the feasibility of using laryngeal mask airway （LMA） in medical rescue by analyzing the security, ventilation data and complications of laryngeal mask airway （LMA）. Methods One hundred randomly selected patients undergoing elective surgery under general anesthesia were randomly divided into 2 equal groups： Group A undergoing insertion of LMA by 10 anesthesiologists, who had used LMA no more than 20 times and Group B undergoing insertion of LMA by 10 experienced anesthesiologists, who had used LMA more than 100 times. The LMA was inserted when the bispectral index reached 50, then controlled ventilation was performed. The frequency and tidal volume（VT） were adjusted according to the end-tidal carbon dioxide partial pressure （PETCO2）. The peak inflation pressure （Ppeak） was maintained between 1-30 cmH20 and the PETCO2 between 33-55 mmHg ,and pulse blood oxygen saturation rate （SpO2） I〉96% .Meanwhile the difficulty, security, ventilation data, find complications of inserting laryngeal mask were recorded. Results Insertion of LMA and mechanical ventilation were successful in both groups without significant statistical difference in inserting difficulty and security between them （both P〉 0.05）. The Ppeak values at T3 and T4 in both groups were all significantly higher than those at T2 （all P〈 0.05）. Only 4 patients complained of sore throat ,1 complained of gastric distension in Group A, and 2 patients complained of sore throat in group B. No intraoperative awareness occurred in both groups. Conclusion Safe and efficient, LMA shows strong operability, airway tolerance and comfortability, and can be considered to be used in medical rescue.