喉罩全麻患者正压通气1h后的喉罩位置变化

Changes of laryngeal mask position after positive pressure ventilation for one hour in patients with laryngeal mask general anesthesia

目的观察正压通气1 h后喉罩相对于声门和声门外结构的解剖位置改变情况。方法选择进行择期手术的患者70例为研究对象。全身麻醉诱导后置入喉罩,在可视软性支气管镜于喉罩成功置入后5 min和1 h时分别评估会厌、声门和罩囊的位置。结果喉罩置入后61.19%患者的罩囊处于最佳位置,23.88%位置过深;正压通气1 h后罩囊处于最佳位置的比例降低至40.30%,位置过深的比例增加至37.31%,差异均有统计学意义(χ^2分别=5.85、6.49,P均<0.05)。88.06%的患者可见会厌,并且17.91%患者的会厌进入喉罩管腔,正压通气1 h后并未发生明显变化。92.54%的患者可见声带,正压通气1 h后声带可见的比例降低至80.60%(χ^2=4.11,P<0.05)。88.06%的患者可见杓状软骨,且8.96%患者的杓状软骨进入喉罩管腔,正压通气1 h后杓状软骨可见性无明显变化(χ^2=2.57,P>0.05),杓状软骨进入喉罩管腔的比例增加至28.36%(χ^2=8.31,P<0.05)。结论在正压通气期间喉罩存在不同程度的位置改变,术中应用可视设备检查罩囊与喉部结构的位置改变有助于提早发现喉罩的移位。

Objective To investigate the changes of the anatomical position of the laryngeal mask(LMA)relative to the glottis and vestibular structures after positive pressure ventilation(PPV)for one hour.Methods A total of 70 patients who underwent elective surgery were selected.The LMA was placed after anesthesia induction,the positions of epiglottis,glottis and capsule were evaluated by visual bronchoscopy at 5 min and 1 h after PPV.Results The cuff of LMA was 61.19%in the optimal position and 23.88%was too deep.At 1 hour after PPV,the proportion of the cuff in the optimal position was decreased to 40.30%(χ^2=5.85,P<0.05),and the proportion of the cuff in too deep position was increased to 37.31%(χ^2=6.49,P<0.05).The epiglottis was visible in 88.06%of patients,and the epiglottis entered the lumen of the LMA in 17.91%of patients.No significant change occurred after 1 h of PPV.Vocal cords were visible in92.54%of patients,and decreased to 80.60%at 1 h after PPV(χ^2=4.11,P<0.05).Arytenoids was visible in 88.06%of patients,and 8.96%of arytenoids protruding into LMA lumen.There was no significant change in visibility of arytenoids at 1 h after PPV(χ^2=2.57,P>0.05),but the proportion of arytenoid protruding into LMA lumen increased to 28.36%(χ^2=8.31,P<0.05).Conclusion The position of the LMA changed to varying degrees during PPV,and intraoperative use of visual equipment to check the position of the cuff and laryngeal structure was recommended to early detection of the displacement of LMA.