纤维支气管镜定位Supreme喉罩在侧卧位肾脏手术中的应用

Application of fiberoptic bronchoscopy positioning supreme laryngeal mask airway in kidney operation with lateral position

目的：探讨纤维支气管镜（纤支镜）定位Supreme喉罩用于肾脏手术的麻醉效果。方法：选择侧卧位肾脏手术60例,ASAⅠ-Ⅱ级,随机分为Supreme喉罩组（SLMA组）和气管插管组（TT组）,各30例,麻醉诱导插管后,观察平均动脉压（MAP）、心率（HR）、呼气末二氧化碳分压（PETCO2）等指标。记录2组导管插入的一次成功率、二次成功率、麻醉并发症以及拔管期的不良反应。结果：SLMA组一次成功率90.0%,二次成功率100.0%。SLMA组各时间点的MAP和HR变化均不明显（P〉0.05）,TT组插管后T2-T5时间点的MAP和HR均较T1显著升高（P〈0.01）,TT组T2-T5MAP和T2-T4HR均高于SLMA组（P〈0.05-P〈0.01）。SLMA组的呛咳和24 h内气道并发症均少于TT组（P〈0.05）。SLMA组一次成功率90.0%,二次成功率100.0%。结论：Supreme喉罩使用纤支镜定位后,可以安全用于侧卧位肾脏手术的麻醉管理。

Objective： To observe the anesthetic effects of fiberoptic bronchoscopy positioning supreme laryngeal mask airway（ SLMA）in kidney operation with lateral position. Methods： Sixty patients with ASA Ⅰto Ⅱ treated with lateral position kidney operation were randomly divided into SLMA group（ 30 cases） and tube intubation group（ TT group,30 cases）. The levels of MAP,HR and PETCO2 were observed after intubation tube under anesthesia. The success rates of the first and second intubation,anesthetic complications and extubation response were recorded. Results： The success rates of the first and second intubation in SLMA group were 90. 0% and 100.0%,respectively. The changes of MAP and HR levels at all time-points were not significant in SLMA group（ P〉0. 05）,the levels of MAP and HR at T2 to T5time-points were significantly higher than those in T1time-point in TT group（ P〈0. 01）. The increasing of MAP in T2 to T5time-points and HR in T2 to T4time-points in TT group were higher than those in SLMA group（ P〈0. 05 to P〈0. 01）. The cough and airway complications in 24 hours in SLMA group were less than those in TT group（ P〈0. 05）. Conclusions： The fiberoptic bronchoscopy positioning SLMA can be safely used in the anesthetic management of kidney operation with lateral position.