新型双管喉罩在肝硬化患者行食管胃底静脉曲张硬化剂联合组织胶注射治疗中的应用

Application of new double-tube laryngeal mask airway in the treatment of esophageal and gastric varices sclerotherapy combined with tissue glue injection in patients with liver cirrhosis

目的探讨新型双管喉罩在肝硬化患者行食管胃底静脉曲张硬化剂联合组织胶注射治疗中的效果和安全性。方法选取2021年8月至2023年7月在首都医科大学附属北京地坛医院择期胃镜下行食管胃底静脉曲张硬化剂联合组织胶注射治疗的肝硬化患者80例进行前瞻性研究。采用随机数字表法将患者分为观察组和对照组,每组40例。对照组给予开口器置入后面罩吸氧,观察组采用新型双管喉罩,给予喉罩置入连接呼吸管路吸氧。比较2组患者麻醉前(T_(1))、喉罩/咬口器置入后(T_(2))、置入内镜后5 min(T_(3))、退出内镜时(T_(4))的平均动脉压(MAP)、心率、脉搏血氧饱和度(SpO_(2))和脑电双频指数(BIS),手术过程中不良反应发生情况,以及术后医生满意度和患者满意度。结果2组患者年龄、性别、体重指数、美国麻醉医师协会分级、手术时间、麻醉时间、丙泊酚用量比较差异均无统计学意义(均P>0.05)。2组各时点MAP、心率、BIS值比较差异均无统计学意义(均P>0.05)。观察组T_(2)、T_(3)、T_(4)时点SpO_(2)均高于对照组[(96.6±2.4)%比(94.3±3.3)%、(97.1±2.1)%比(92.2±3.9)%、(96.1±1.5)%比(95.3±1.9)%],差异均有统计学意义(均P<0.05)。观察组低氧血症发生率明显低于对照组[2.5%(1/40)比20.0%(8/40)],差异有统计学意义(P<0.05);2组其他不良反应发生率比较差异均无统计学意义(均P>0.05)。观察组医生满意度明显高于对照组[97.5%(39/40)比52.5%(21/40)],差异有统计学意义(P<0.001);2组患者满意度比较,差异无统计学意义(P=0.709)。结论新型双管喉罩在肝硬化患者行食管胃底静脉曲张硬化剂联合组织胶注射治疗中可保障患者氧合,安全性较好。

Objective To investigate the efficacy and safety of new double-tube laryngeal mask airway in the treatment of esophageal and gastric varices sclerotherapy combined with tissue glue injection in patients with liver cirrhosis.Methods A prospective study was conducted on 80 patients with liver cirrhosis who were treated with esophagogastric varices sclerotherapy combined with tissue glue injection under gastroscopy in Beijing Ditan Hospital,Capital Medical University from August 2021 to July 2023.The patients were divided into observation group and control group by random number table method,with 40 cases in each group.The control group was given oxygen inhalation with the mask after the mouth opener placement,and the observation group was given oxygen inhalation with the new double-tube laryngeal mask inserted and connected with the breathing tube.The mean arterial pressure(MAP),heart rate,pulse oxygen saturation(SpO_(2)),and bispectral index(BIS)were recorded and compared before anesthesia(T_(1)),after laryngeal mask/bite placement(T_(2)),5 min after placement(T_(3))and at the time of exit from the endoscope(T_(4)).The incidence of adverse reactions and postoperative satisfaction of patients and doctors were compared between the two groups.Results There were no statistically significant differences in age,gender,body mass index,American Society of Anesthesiologists classification,operation time,anesthesia time,and propofol dosage between the two groups(all P>0.05).There were no significant differences in MAP,heart rate and BIS value between the two groups at each time point(all P>0.05).At T_(2),T_(3),and T_(4)time points,the SpO_(2)in the observation group were higher than those in the control group[(96.6±2.4)%vs(94.3±3.3)%,(97.1±2.1)%vs(92.2±3.9)%,(96.1±1.5)%vs(95.3±1.9)%](all P<0.05).The incidence of hypoxemia in the observation group was significantly lower than that in the control group[2.5%(1/40)vs 20.0%(8/40)](P<0.05).There were no statistically significant differences in the incidences of other adverse reactions between the two groups(both P>0.05).The satisfaction of doctors in the observation group was significantly higher than that in the control group[97.5%(39/40)vs 52.5%(21/40)](P<0.001).There was no statistically significant difference in patient satisfaction between the two groups(P=0.709).Conclusion The new double-tube laryngeal mask airway can ensure oxygenation and has good safety in the treatment of esophageal and gastric varices sclerotherapy combined with tissue adhesive injection in patients with liver cirrhosis.