两种喉罩定位方法在鼻内窥镜手术中的应用

The application of two positioning for laryngeal mask airway in endoscopic sinus surgery

目的观察听诊和纤维支气管镜评分两种喉罩定位方法在鼻内窥镜手术中的应用。方法将60例使用喉罩通气全麻的成年患者随机分为2组,分别通过听诊法(L组)和纤维支气管镜评分法(F组)评估喉罩位置,记录置入情况和纤维支气管镜评分,潮气量(Vt)、呼气末二氧化碳分压(P_(ET)CO_2)、气道峰压(Peak)和最大漏气压。结果听诊法和纤维支气管镜评分法判断喉罩对位后,两组患者最大漏气压、Vt、P_(ET)CO_2、Peak差异均无统计学意义(P>0.05)。L组喉罩一次到位成功25例,明显高于F组(15例,P<0.05)。两组患者喉罩对位后纤支镜评分差异有统计学意义(P<0.05),L组有15例患者纤支镜评分为2分,F组所有患者评分均在3分以上。结论采用听诊法和纤维支气管镜评分定位法判断喉罩对位都可以满足临床通气需要。听诊法简单可靠,即使纤支镜评分2分,也可达到良好的通气和密闭效果,满足手术需要。

Objective To observe the application of auscultation and fiberoptic bronchofibroscope （FOB） score for laryngeal mask airway （LMA） in endoscopic sinus surgery （ESS）. Methods Sixty adult patients who underwent general anesthesia and LMA ventilation were randomly divided into two groups. The LMA positioning was evaluated by auscultation and fiberoptic bronchofibroscope score. The success rate of LMA insertion and fiberoptic bronchofibroscope score, tidal volume （Vt）, end-tidal carbon dioxide partial pressur（PETCO2）, peak pressure （Peak）, Max oropharyngeal leak pres- sure were recored. Results There was no statistical difference between auscultation and FOB groups in max oropharyn- geal leak pressure, Vt, PETCO2, Peak （P 〉 0.05）. The successful cases of LMA insertion for the first time in the auscultation group were 25 patients, which was significantly higher than in the FOB group （15 cases, P 〈 0.05）. FOB scores in two groups were significantly different （P 〈 0.05）. Fifteen cases in the auscultation group were scored 2 points by FOB, all cas- es in the FOB group were scored more than 3 points. Conclusion Both auscultation and fiberoptic bronchoscope score used to evaluate the LMA positioning can meet the clinical needs of ventilation. Evaluation by auscultation method in LMA positioning is simple and reliable, which could achieve good ventilation and sealing effect even if fiberoptic bron- choscopy score is 2 points only.