肥胖患者面罩通气时左侧气管旁与环状软骨按压效果的比较

Comparison of effects of left paratracheal pressure and cricoid pressure during mask ventilation in obese patients

目的比较肥胖患者面罩通气时左侧气管旁与环状软骨按压的效果。方法拟行全身麻醉患者60例,性别不限,年龄18~60岁,28 kg/m^(2)≤BMI<35 kg/m^(2),ASA分级Ⅰ或Ⅱ级。采用随机数字表法将患者分为2组(n=30):左侧气管旁按压组(LPP组)和环状软骨按压组(CP组)。LPP组在气管旁、锁骨上方向椎体方向按压,CP组在环状软骨向下按压,按压力度为25~35 N。观察食管、气管和环状软骨的空间关系,面罩通气时胃窦部是否有空气影,面罩通气前后胃窦横截面积(CSA)和面罩通气时气道压力。结果在锁骨上区域2组患者食管均位于气管左侧。2组患者面罩通气时气道压和面罩通气前胃窦CSA比较差异无统计学意义(P>0.05);与LPP组相比,CP组面罩通气时胃窦部有空气影患者比率升高,面罩通气后胃窦CSA增加(P<0.05)。结论与环状软骨按压相比,左侧气管旁按压可降低肥胖患者面罩通气时空气进入胃内的发生,减少面罩通气后胃窦CSA。

Objective:To compare the effects of left paratracheal pressure(LPP)and cricoid pressure(CP)during mask ventilation in obese patients.Methods:Sixty patients of either sex,aged 18-60 yr,with 28 kg/m^(2)≤body mass index<35 kg/m^(2),of American Society of Anesthesiologists Physical Status classificationⅠorⅡ,scheduled for general anesthesia,were divided into 2 groups(n=30 each)using a random number table method:LPP group and CP group.In LPP group,pressure was applied beside the trachea,above the clavicle towards the vertebral direction,while in CP group,pressure was applied downwards to the cricoid cartilage,with a force of pressure between 25-35 N.The spatial relationship between the esophagus,trachea,and cricoid cartilage,the presence of air shadows in the gastric antrum during mask ventilation,and the cross-sectional area(CSA)of the gastric antrum before and after mask ventilation as well as the airway pressure during mask ventilation were observed.Results:In both groups,the esophagus was located in the left of the trachea in the supraclavicular region.There were no statistically significant differences in the airway pressure during mask ventilation and the CSA of the gastric antrum prior to mask ventilation between the two groups(P>0.05).Compared to LPP group,the proportion of patients with air shadows in the gastric antrum during mask ventilation was significantly increased,and the CSA of the gastric antrum was increased after mask ventilation in CP group(P<0.05).Conclusions:Compared to CP,LPP can decrease the development of air entering the stomach during mask ventilation and reduce the CSA of the gastric antrum after mask ventilation in obese patients.