喉罩通气与气管插管通气在烧伤患者全麻气道管理中的安全性和可行性分析

Comparison of the safety and feasibility of laryngeal mask airway and endotracheal tube ventilation in airway management of burn patients under general anesthesia

目的 分析喉罩(LMA)通气与气管插管(ETT)通气在烧伤患者全身麻醉(全麻)气道管理中的安全性和可行性。方法 80例烧伤患者,采取随机数字表法分为喉罩组与气管插管组,每组40例。喉罩组采用喉罩通气,气管插管组采用气管插管通气。对比两组并发症发生率及围麻醉期不同时间点[麻醉前(T1)、置入喉罩或者气管导管前(T2)、置入喉罩或者气管导管即刻(T3)、置入喉罩或者气管导管后5 min(T4)、拔除喉罩或者气管导管前(T5)、拔除喉罩或者气管导管即刻(T6)]的心率(HR)、平均动脉压(MAP)、血氧饱和度(SpO2)、呼气末二氧化碳分压(PETCO2)水平。结果 两组T1时HR及MAP比较差异无统计学意义(P>0.05);两组T2时HR及MAP均低于T1,T3时HR及MAP高于T2,差异具有统计学意义(P<0.05);气管插管组T2时HR及MAP均低于喉罩组,T3、T4、T5、T6时HR及MAP均高于喉罩组,差异具有统计学意义(P<0.05);两组T4时HR及MAP均低于T3,差异具有统计学意义(P<0.05);喉罩组T5时HR及MAP均高于T4,差异具有统计学意义(P<0.05);两组T5与本组T6的HR及MAP比较差异无统计学意义(P>0.05);喉罩组与气管插管组T1、T2、T3、T4、T5、T6的SpO2及PETCO2比较差异无统计学意义(P>0.05)。喉罩组并发症发生率为5.00%,明显低于气管插管组的25.00%,差异具有统计学意义(P<0.05)。结论 喉罩通气应用于烧伤患者中能够发挥较好的全身麻醉气道管理的效果,置入操作比较方便,不容易引起应激反应,并发症发生率较低,安全性较高。

Objective To analyze the safety and feasibility of laryngeal mask airway(LMA)ventilation and endotracheal tube(ETT)ventilation in airway management of burn patients under general anesthesia.Methods A total of 80 burn patients were divided into laryngeal mask airway group and endotracheal tube group by random number table method,with 40 cases in each group.Laryngeal mask airway group received laryngeal mask for ventilation,and endotracheal tube group received endotracheal tube for ventilation.The incidence of complications,heart rate(HR),mean arterial pressure(MAP),oxygen saturation(SpO2)and pressure of end-tidal carbon dioxide(PETCO2)at different time points of perianesthesia[before anesthesia(T1),before laryngeal mask or tracheal tube insertion(T2),immediately after laryngeal mask or tracheal tube insertion(T3),5 min after laryngeal mask or tracheal tube insertion(T4),before laryngeal mask or tracheal tube removal(T5),immediately after laryngeal mask or tracheal tube removal(T6)]were compared betwee the two groups.Results At T1,there was no statistically significant difference in HR and MAP between the two groups(P>0.05).The levels of HR and MAP at T2 in the two groups was lower than those at T1,and the levels of HR and MAP at T3 was higher than those at T2.Their difference was statistically significant(P<0.05).At T2,the levels of HR and MAP in endotracheal tube group was lower those in laryngeal mask airway group.At T3,T4,T5,T6,the levels of HR and MAP in endotracheal tube group was higher than those in laryngeal mask airway group.Their difference was statistically significant(P<0.05).At T4,the levels of HR and MAP in the two groups was lower than those at T3,and the difference was statistically significant(P<0.05).At T5,the levels of HR and MAP in laryngeal mask airway group was higher than those at T4,and the difference was statistically significant(P<0.05).At T5 and T6,there was no statistically significant difference in levels of HR and MAP between the two groups(P>0.05).At T1,T2,T3,T4,T5 and T6,there was no statistically significant difference in SpO2 and PETCO2 between the two groups(P>0.05).The incidence of complications was 5.00%in laryngeal mask airway group,which was obviously lower than 25.00%in endotracheal tube group,and the difference was statistically significant(P<0.05).Conclusion Laryngeal mask airway can play a better role in airway management of general anesthesia in burn patients.It is convenient to put in and not easy to cause stress reaction with low incidence of complications and high safety.