I-gel喉罩在老年无牙齿患者全身麻醉中通气效果的临床观察

Clinical observation of ventilation effect of I-gel supraglottic airway used in general anesthesia in elderly edentulous patients

目的通过与牙齿正常老年患者的喉罩通气效果比较,观察I-gel喉罩在老年无牙齿患者全身麻醉中的应用效果,从而为临床提供参考。方法此次研究中,选择60例在全麻下行腹股沟疝修补术的老年男性患者作为实验研究对象,均为杭州师范大学附属医院于2014年5月—2015年5月期间所接收,分为无牙齿组(NT组)和正常组(T组),每组30例,根据体重选择喉罩型号,麻醉诱导后置入喉罩,进行机械通气。记录诱导前(T0)、置入喉罩后即刻(T1)、3 min(T2)及拔出喉罩前(T3)、拔出后即刻(T4)、3 min(T5)患者平均动脉压和心率;记录2组喉罩的置入时间、置入次数、纤支镜对喉罩对位的分级、气道密封压、相关并发症及血气分析;比较手术前后患者的通气效果。结果 NT组的喉罩置入时间及置入次数多于T组,但差异无统计学意义(P>0.05);2组的喉罩置入成功率、喉罩对位情况、气道密封压及漏气情况差异无统计学意义(P>0.05);2组患者置入和拔出喉罩时的血流动力学平稳,且其他并发症2组间差异无统计学意义(P>0.05)。结论 I-gel喉罩通气置入后与喉周组织呈镜像吻合,有效减少对喉周组织的压迫,为老年患者提供更安全的麻醉环境。并可有效预防老年无牙齿患者全麻术中因通气所引起的血流动力学的波动,降低术中不良事件的发生率,在临床中具有重要的作用。

Objective To observe the ventilation effect of I-gel Laryngeal Mask Airway（LM） in the general anesthesia in elderly edentulous patients by comparing with dentate patients, so as to provide reliable data for clinical. Methods In this study,60 elderly male patients with inguinal hernia repair under general anesthesia in our hospital from May ,2014 to May,2015 were selected and divided into no tooth group（ group NT） and the normal group（ group T） with 30 cases in each group. The type of laryngeal mask was chosen according to the body weight. The laryngeal mask was placed after in- duction of anesthesia to perform mechanical ventilation. Mean arterial pressure（MAP） and heart rate（HR） were recorded before intubation （ TO ）, during intubation （ T1 ）, at 3 rain after intubation （ T2 ） and before extubation （ T3 ）, during extubation （T4）, at 3 min after extubation （T5） ;The time for LM intubation, attempt times of intubations, the class of position by flexible fiberoptic bronchoscopy, airway leak pressure, the related complications and blood gas analysis were recorded. The ventilation condition was also compared in the two groups before and after the operation. Results The insertion time of laryngeal mask airway in NT group was （ 8 ± 5 ） s and the number of times was more than T group [ （ 7 ± 7 ） s ], the difference was not statistically significant（P 〉 0.05 ） ;There was no difference in the success rate of laryngeal mask insertion, laryngeal mask airway, airway seal pressure and air leakage between the two groups （ P 〉 0.05 ） ; The hemodynamics of the two groups were stable and the other complications were not different between the two groups （ P 〉 0.05 ）. Conclusion I- gel supraglottie airway can enable a mirrored impression of the pharyngeal and laryngeal structures and can effectively reduce the pressure on the laryngeal tissue and provide a more secure environment for the elderly patients,it can also effectively prevent the hemodynamic fluctuations during general anesthesia due to ventilation in elderly edentulous patients, and reduce the incidence of adverse events during the operation,which shows an important role in the clinical practice.