自制口面部支撑器在无齿老年患者全身麻醉诱导中的应用

Application of self-made mouth-facial supporter in edentulous elderly patients during induction of general anesthesia

目的评价自制口面部支撑器在老年无齿患者全身麻醉面罩通气过程中的应用效果。方法65岁以上ASAⅡ～Ⅲ级全身麻醉手术患者186例，男女不限，其中牙齿健全或牙齿缺失≤4颗的患者70例，设为A组，无齿患者共116例，随机分为B、C组，其中B组使用支撑器，C组不使用支撑器。在吸入氧流量为3L／min，限压阀压力30cmH2O（1cmH2O：0．09806kPa）的条件下，由麻醉医师单手托面罩机控面罩通气，观察并记录实际潮气量、脉搏氧饱和度、血压、心率等指标。结果A、B、C组患者面罩通气成功率分别为75．7％、83．3％和17．9％。A、B组的成功率均远高于C组（P〈0．05）。A、B、C组患者面罩通气漏气率分别为17．45％、18．17％、61．07％。A、B组患者漏气率低于C组（P〈0．05）。结论无齿老年患者面罩通气不足的发生率为82．1％，使用自制口面部支撑器可使老年无齿患者面罩通气成功率大幅提高，其成功率与牙齿健全老年人无明显差异。

Objective To evaluate the application of self-made mouth-facial supporter in edentulous elderly patients during induction of general anesthesia. Methods One hundred and eighty four patients over 65 and with ASA class Ⅱ-Ⅲ, who underwent general anesthesia, were recruited in this study. Patients with obvious airway malformations were excluded. Patients with complete dentures or dental deficiency ≤4 teeth were assigned to group A, and the edentulous patients were divided into two groups （group B and C） randomly. The mouth-facial supporter was used in group B during mask ventilation, but not in group C. Blood pressure, pulse oxygen saturation, heart rate and practical tidal volumes were recorded during the induction of anesthesia. Mechanical mask ventilation （IPPV） were performed in three groups with the condition of 3 L/min FiO2, 30 cmH20（ 1 cmH2O=0. 098 06 kPa） pressurelimiting （APL）. And the experienced anesthesiologist held the mask with one hand. If the ventilation after 3 min was satisfying, endotracheal intubation was performed, and then the study ended; while there was any sign of inadequate ventilation, a series of measure should be taken, otherwise LMA or other emergency pathway of airway opening will be done to ensure the patients safety. Results There were no significant differences in age, BMI, mouth opening or thyromental distance among patients of the three groups. The mask ventilation success rate of group A, group B and group C were 75.7%, 83.3% and 17.9% respectively; and those in groups A and B were significantly higher than that in group C （P 〈 0. 05 ）. Conclusion The success rate of mask ventilation of in edentulous elderly patients can be improved by using the self-made mouth-facial supporter.