非麻醉医生对全麻患者两种方法置入Proseal喉罩的对比研究

Comparison of two insertion techniques of proseal laryngeal mask airway performed by non-anesthesiologists in general anesthesia

目的比较非麻醉医生对全麻患者使用钢丝塑形置入法与食指推送法置入Proseal喉罩(PLMA)的有效性和安全性。方法将120例行择期腹腔镜胆囊切除手术患者按随机数字表法分为改良组和对照组,每组60例。由20位没有使用喉罩经验的非麻醉医生在麻醉医生带教下行PLMA置入操作,每人随机选择6例患者行喉罩置入(其中改良组3例,对照组3例),改良组使用钢丝塑形置入法,对照组使用食指推送法。记录两种方法置入PLMA的成功率、置入时间、置入前后1min心率(HR)和平均动脉压(MAP),以及置入后胃管插入成功率,行纤维支气管镜(FOB)定位评分,测定口咽漏气压(OLP)、气腹前气道峰压(PIP)、气腹后PIP,观察有无术中漏气及反流误吸、术后喉罩沾血和咽喉疼痛等并发症。结果改良组置入喉罩首次成功率及总成功率均高于对照组(P<0.05或0.01),置入时间明显少于对照组(P<0.01)。两组患者置入喉罩前后1min的HR和MAP变化均无统计学差异(均P>0.05)。两组患者均顺利插入胃管,OLP、FOB评分≥3分例数、气腹前PIP、气腹后PIP、术中漏气更换气管插管例数比较均无统计学差异(均P>0.05),术中均未发生反流误吸。术后改良组喉罩沾血和咽喉痛例数均少于对照组(P<0.05或0.01)。结论相对于食指推送法,没有喉罩使用经验的非麻醉医生采用钢丝塑形置入法能迅速有效地对全麻患者置入PLMA,成功率更高,时间更短,术中气道管理安全有效,术后咽喉并发症也较少。

Objective To compare the efficacy and safety of two insertion techniques of proseal laryngeal mask airway（PLMA） performed by Non-anesthesiologists in general anesthesia.Methods One hundred and twenty patients undergoing elective laparoscopic cholecystectomy were randomly allocated in the study group or control group（n=60 in each group）.The PLMA were inserted by 20 non-anesthesiologists under the supervision of experienced anesthesiologists,all the operators had no previous experience laryngeal mask airway insertion.Each operator randomly performed on 6 randomly chosen patients（3 in study group and 3 in control group）.In the study group,PLMA was inserted by the wire shaped technique,while in the control group,PLMA was inserted by the index finger manipulation.The success rate and insertion time were documented.Heart rate（HR）and mean arterial pressure（MAP） were measured 1 min before and after insertion.The success rate of inserting the gastric tube,score of fiberoptic bronchoscope（FOB） location,oropharyngeal leak pressure（OLP） and peak airway pressure（PIP） before and after pneumoperitoneum were also documented.Intraoperative and postoperative complications were observed.Results The success rate of insertion at the first attempt and the overall success rate was higher in study group（P〈0.05 or 0.01）.The time taken for insertion in the study group was significantly less than that in the control group（P〈0.01）.There were no significant differences in HR and MAP 1 min before and after insertion between two groups（P〉0.05）.The gastric tubes were inserted smoothly in all patients.There were no significant differences in OLP,numbers of FOB score 3,PIP before and after pneumoperitoneum,numbers of patients exchanged with endotracheal tube during operation between the two group（P〉0.05）.There was no regurgitation and aspiration during operation in both groups.The incidence of blood staining（P〈0.01） and sore throat（P〈0.05）was lower in the study group.Conclusion Compared to the traditional index finger manipulation,non-anesthesiologists can insert PLMA safely and effectively by using wire shaped technique with higher success rate,shorter time taken and less postoperative complications.