Supreme喉罩对位不良的原因观察

Root cause analysis on poor position of Supreme laryngeal mask airway

目的:本研究旨在观察分析Supreme喉罩(SLMA)对位不良的原因。方法:对SLMA置入时出现对位不良的患者,利用纤支镜观察和超声实时成像检查的方法明确SLMA对位不良时的位置、原因。结果:22例初次置入对位不良的SLMA应用患者纳入观察。12例患者经再次尝试后置入成功,其余患者经其他器械辅助后成功。对位良好时SLMA位置:喉罩的食管引流管尖端已入食道入口,气囊位于甲状软骨及会厌软骨的背侧。对位不良时SLMA位置:喉罩的食管引流管尖端尚未进入食道入口,止于声门联合后缘、杓状软骨上方,气囊位于会厌软骨及舌根的背侧。结论:SLMA置入深度不足,喉罩前端不能进入食管入口,是SLMA对位不良的主要原因;而阻隔喉罩前端进一步置入食管入口的障碍主要是喉的背侧结构,如声门联合后缘或杓状软骨。

Objective：To conduct a root cause analysis on the deficient position of Supreme laryngeal mask airway （ SLMA） .Methods：Poor position of the SLMA in patients was corrected under assistance of fiber-optic bronchoscope （FOB） and portable ultrasound system,and the root causes were analyzed. Results：Totally,poor position occurred in 22 cases by initial attempt.Position was successful by second try in 12 cases,and the remaining were managed with auxiliary equipments.Perfect SLMA position relied on access of the suction tube tip to the entry point of esophagus ,and the airbag was maintained at the dorsal thyroid cartilage and epiglottis,whereas deficient position was associated with a gap between the suction tube tip and entry point of the esopha-gus,and the tube tip being just kept over the joint of vocal cords and arytenoids cartilage as well as the airbag was stuck at the back of tongue root and epi-glottis.Conclusion：Poor position of the SLMA is primarily involved in deficient insertion of the tube into the esophagus ,and the insertion deficiency is as-sociated with the dorsal structure of the larynx,such as the subglottic joint or arytenoids cartilage.