自身对照观察经预充气和再充气鸣人喉罩气管插管的临床效果

Comparision of the clinical effect of endotracheal intubation via preinflated and reinflated BlockBuste laryngeal mask

目的自身对照观察经预充气和再充气鸣人喉罩可视软镜引导下气管插管的临床效果。方法选择拟在插管全身麻醉下手术的患者52例,所有患者均接受喉罩罩囊预充气和再充气处理。静脉麻醉诱导,待下颌松弛后置入喉罩,预充气可视软镜检查声门显露分级和声门位置,导引气管导管尖端进入气管内(软镜不进声门);再充气置入喉罩后向罩囊再次充气至囊内压60 cmH_(2)O,其余操作步骤与预充气相同。观察并记录经喉罩可视软镜下声门显露分级、声门位置;经喉罩气管插管次数与成功率;记录术毕喉罩拔出时表面染血情况、气管拔管时气管导管末端染血情况及术后24 h不良反应的发生情况。结果患者喉罩罩囊预充气时,声门显露分级为1级和2级40例(76.9%);患者喉罩罩囊再充气时,声门显露分级为1级和2级48例(92.3%),高于喉罩罩囊预充气时(P<0.05)。喉罩罩囊再充气的情况下,声门位置为中位的占比高于喉罩罩囊预充气(P<0.05)。喉罩罩囊预充气时,经喉罩气管插管一次成功43例,失败9例,其中经过调整声门位置后第2次气管插管成功3例,因声门位置太高最终气管插管失败6例;喉罩罩囊再充气时,经喉罩气管插管一次成功50例,失败2例,其中经过旋转气管导管后第2次气管插管成功1例。喉罩罩囊再充气时经喉罩气管插管的第1次成功率要高于喉罩罩囊预充气时(P<0.05)。结论经鸣人喉罩气管插管时,罩囊再充气法能显著改善声门的显露分级,改善插管条件,提高首次气管插管成功率。

Objective To observe the clinical effect of endotracheal intubation via preinflated and reinflated BlockBuster laryngeal mask airway(LMA).Methods A total of 52 patients were selected for intubation and surgery under general anesthesia,and all patients underwent preinflation and reinflation of the LMA cuff.After induction of intravenous anesthesia,a LMA was placed after the jaw had relaxed,a visual flexible endoscope was preinflated to check the grading and position of the glottis exposure,and the tip of the tracheal catheter was guided into the trachea(the flexible endoscope did not enter the glottis).After reinflating and inserting the LMA,the cuff was reflated until the pressure inside the cuff was 60 cmH_(2)O.The other procedures were the same as those of preinflation.The grading of glottic exposure and glottic position under the visual flexible endoscope via the LMA were observed and recorded.The number and success rate of endotracheal intubation via LMA,the surface blood staining during the removal of the LMA after surgery,the blood staining at the end of the tracheal catheter during tracheal extubation,and the occurrence of adverse reactions at 24 h after surgery were recorded.Results Forty patients(76.9%)had glottic exposure grade 1 and grade 2 during preinflation of the LMA cuff;Forty-eight patients(92.3%)had glottic exposure grade 1 and grade 2 during the reinflation of the LMA cuff,which were higher than those during the preinflation of the LMA cuff(P<0.05).In the case of reinflation of the MA cuff,the proportion of glottis position in the median section was higher than that of preinflation of the LMA cuff(P<0.05).During the preinflation of the LMA cuff,43 patients were successfully intubated via the LMA at the first attempt,and intubation was failed in 9 patients.Among them,3 patients were successfully intubated at the second attempt after adjusting the glottis position,and intubation was failed in 6 patients due to the high glottis position.When the LMA cuff was reinflated,50 patients were successfully intubated via the LMA at the first attempt,and intubation was failed in 2 patients,of whom 1 case was successfully intubated at the second attempt after the rotation of the tracheal catheter.The first-attempt success rate of endotracheal intubation via LMA during the reinflation of the LMA cuff was higher than that during the preinflation of LMA cuff(P<0.05).Conclusion When endotracheal intubation is carried out via BlockBuster LMA,the method of cuff reinflation can significantly improve the glottis exposure grade,the conditions of intubation,and the first-attempt success rate of endotracheal intubation.