喉罩用于全麻剖宫产术气道管理效果的回顾性分析

A retrospective analysis of laryngeal mask airway for airway management in cesarean section under general anesthesia

本院2011年1月至2013年12月产妇13 331例中,剖宫产术6162例,剖宫产率为46.223％,其中全麻的构成比为1.75％,而采用全麻的产妇中急诊构成比为60.2％,ASA分级≥Ⅲ级的危重产妇构成比为16.7％.椎管内麻醉禁忌和失败是选择全麻的主要原因.全麻下产妇108例,其中喉罩组33例,气管导管组75例.2组一般情况各指标、急诊比例、产妇和新生儿入住ICU的治疗率、新生儿Apgar评分比较差异无统计学意义（P＞0.05）.2组均无困难气道,麻醉期间均未发生误吸等.综上所述,全麻主要适用于椎管内麻醉禁忌和失败的剖宫产术,且急诊手术比例较高;喉罩可用于全麻剖宫产术气道管理,但须正确放置,保证密封性良好,以预防误吸.

Among 13 331 parturients from January 2011 to December 2013 in Peking University First Hospital, 6 162 cases required cesarean section, and the rate of cesarean section was 46.223%.The constituent ratio of cesarean section under general anesthesia was 1.75%, the constituent ratio of emergency cesarean section under general anesthesia was 60.2%, and the constituent ratio of the critically ill patients of ASA physical status ≥ Ⅲ was 16.7%.The main indication for general anesthesia was contraindication to neuraxial anesthesia or failure of neuraxial anesthesia.Of the 108 parturients who underwent cesarean section under general anesthesia, 33 cases were in laryngeal mask airway （LMA） group and 75 cases in intubation group.There was no statistically significant difference between intubation group and LMA group in terms of general data, emergency rate, percentage of patients or neonates admitted to intensive care unit, and neonatal Apgar score （P〉0.05）.There were no airway-related complications such as difficult airway, aspiration or regurgitation in either group.In summary, general anesthesia was mainly suitable for cesarean section contraindicating neuraxial anesthesia and failed cesarean section, and the proportion of emergency operations was higher;LMA could be used for airway management in cesarean section under general anesthesia, but it must be placed correctly ensuring good airway sealing to prevent aspiration.