可弯曲喉罩与加强型气管导管用于俯卧位腰椎手术的比较

Comparison between flexible laryngeal mask airway and reinforced tracheal tube used for lumbar vertebral surgery in prone position

目的:评价可弯曲喉罩(flexible laryngeal mask airway,FLMA)用于俯卧位腰椎手术的安全性和可行性。方法:择期腰椎手术患者120例,随机均分为FLMA组和钢丝加强气管导管(reinforced tracheal tube,RTT)组,全身麻醉诱导后分别置入FLMA或RTT,记录诱导开始时(T0)、人工气道置入时(T1)、置入后1 min(T2)及拔出时(T3)、拔出后1 min(T4)的心率(heart rate,HR)、收缩压(systolic blood pressure,SBP)和舒张压(diastolic blood pressure,DBP)。记录置入时间、置入次数以及平卧位和俯卧位后气道峰压、喉罩气道密封压和纤维支气管镜检查分级,记录手术开始时、手术开始后1 h、手术开始后2 h及手术结束时的气道峰压和喉罩气道密封压。记录拔出人工气道时及之后30 min内有无低氧血症(SpO_2<90%)、喉痉挛、呛咳、呕吐、咽喉痛,人工气道的套囊和管壁内外有无血迹和污物。结果:不同时间点比较,FLMA组SBP、DBP、HR在T2与T1间、T4与T3间差异无统计学意义(P>0.05);RTT组SBP、DBP、HR在T2比T1明显升高(P<0.01),T4比T3明显升高(P<0.05)。两组间比较,T2和T4时FLMA组SBP、DBP和HR均明显低于RTT组(P<0.05)。两组内及两组间各时点气道峰压及纤维支气管镜分级比较,差异均无统计学意义(P>0.05)。拔出人工气道时及拔出后30 min内,FLMA组的呛咳、咽喉痛及声音嘶哑发生率明显小于RTT组(P<0.05)。结论:在严格掌握适应征的前提下,FLMA可用于俯卧位腰椎手术的机械通气,其安全性有待进一步临床验证。与RTT相比较,FLMA围术期循环波动更小,术后呼吸道并发症更少。

Objective：To estimate the safety and feasibility of flexible laryngeal mask airway （FLMA） for lumbar vertebral surgery in prone position.Methods： In the study,120 adult patients scheduled for lumbar vertebral surgery under intravenous general anesthesia were divided into group FLMA and reinforced tracheal tube （RTT） group at random.Heart rate （HR）,systolic blood pressure （SBP） and diastolic blood pressure （DBP） were recorded at the beginning of anesthesia induction （T0） and on the time of artificial airway intubation （T1）,1 min after intubation （T2）,extubation （T3）,1 min after extubation （T4） as well.The number and time required for intubation were recorded.Peak airway pressure （PPEAK）,airway sealing pressure （PAS） in group FLMA and fiberoptic bronchoscopy scale （FBS） were recorded after artificial airway intubation,turned over into prone position and after the operation started,as well as on the time of 1 hour after the operation started,2 hours after operation started and when the operation stopped.Finally,respiratory complications after extubation,including hypoxemia,laryngospasm,coughing,vomiting,hoarseness,and pharyngalgia,were observed and whether there was blood or sewage inside and outside the artificial airway was recorded.Results： There was no difference in the number and time required for intubation between the two groups （P〉0.05）.There was no difference in PPEAK and FBS between the two groups,and also the same at the different time points in each group （P〉0.05）.PAS in group FLMA was the same at the diverse time points during anesthesia （P〉0.05） and always higher than PPEAK in the perioperative period.In group FLMA,there was no difference in HR,SBP and DBP between the time points of T2 and T1,also of T4 and T3 （P〉0.05）.In group RTT,HR,SBP and DBP were significantly higher between the time points of T2 and T1 （P〈0.01）;SBP was significantly higher between the time points of T4 and T3 （P〈0.01）,DBP and HR were higher between the time points of T4 and T3 （P〈0.05）.SBP in group FLMA was significantly lower than in group RTT at T2 （P〈0.01）,HR and DBP were lower than those in group RTT simultaneously （P〈0.05）.On the time point of T4,SBP,DBP and HR in group FLMA were lower than those in group RTT （P〈0.05）.The incidence of coughing and pharyngalgia after extubation was significantly lower in group FLMA than in group RTT （P〈0.01）,with the incidence of hoarseness was lower in group FLMA than in group RTT （P〈0.05）.There was no difference in the incidence of hypoxemia,vomiting and blood seen outside the cuff between the two groups （P〉0.05） while no laryngospasm and sewage seen outside the artificial airway in each group.Conclusion： For suitable patients,FLMA can be used in mechanical ventilation forlumbar vertebral surgery in prone position with more stable circulation and less respiratory complications than RTT.Further clinical validation is needed for the safety of FLMA.