i-gel喉罩通气在无痛纤维支气管镜检查中的应用

目的观察i-gel喉罩通气在无痛纤维支气管镜检查中的应用效果。方法 ASA I-II级拟行无痛纤维支气管镜检查的患者60例,采用随机数字表法,将患者随机分为2组:i-gel喉罩组(I组,n=30)和表面麻醉组(C组,n=30)。前者通过i-gel喉罩联合T型密封接头实施控制通气,后者常规表面麻醉后行纤支镜检查。分别记录麻醉前(T0)、麻醉后纤支镜进入前(T1)、进镜至咽部(T2)、声门部(T3)、气管内(T4)及纤支镜取出后即刻(T5)的6个时点血压(BP)、心率(HR)和脉博血氧饱和度(SpO2),观察镜检期间不良反应;记录两组患者的镜检条件及镜检时间,调查麻醉满意度(由内镜医师评价)及患者满意度(由患者评价)。结果 I组患者术中血流动力学稳定,C组HR、MAP在各时点均升高,与T0比较差异有统计学意义(P<0.05),组间相应时点比较亦有统计学意义(P<0.05);I组患者检查中出现呛咳、憋气、喉痉挛及体动等不良反应明显少于C组(P<0.05)。I组患者的镜检条件明显优于C组(8.27±1.53)分vs.(5.16±1.12)分,P<0.05],镜检时间短于C组(9.83±2.53)min vs.(16.52±4.38)min,P<0.05]。I组患者均能在术毕3～8 min苏醒,麻醉满意度(91.3±7.8)分vs.(6.04±5.7)分]及患者满意度(93.8±8.3)分vs.(48.7±6.6)分]均高于C组(P<0.05)。结论 i-gel喉罩通气用于无痛纤支镜检查,能保证血流动力学稳定,有效控制患者的通气,克服了呼吸抑制问题,改善镜检条件,苏醒快速。

Application of laryngeal mask airway i-gel in painless fiberoptic bronchoscopy

Objective To observe the clinical effect of controlled ventilation with laryngeal mask airway（LMA） i-gel in painless fiberoptic bronchoscopy（FOB）.Methods Sixty ASA I-II grade patients undergoing fiberoptic bronchoscopy were randomized into 2 groups（n=30 each）,LMA i-gel group（group I,n=30 each） and topical anesthesia group（group C,n=30 each）.Controlled ventilation was adopted in Group I,supported by LMA i-gel combined with T-seal adapter.All the patients in group S received topical anesthesia.Heart rate（HR）,non-invasive blood pressure（NIBP） and pulse oxygen saturation（SpO2） were recorded at the fellowing time points,before anesthesia（T0） and immediately after anaesthesia induction（T1） when FOB at the level of pharynx（T2）,vocal cords（T3）,trachea（T4） and immediately out of the FOB（T5）,side-effects during the inspection were also observed.The operating condition and operating time of the two groups were recorded,intra-operative satisfication（evaluated by Endoscopy Doctor） and patient satisfication（evaluated by patient） were also analyzed.Results The hemodynamics were more stable in group I than those in group C.Less irritating cough,breathlessness,laryngospasm,and body movement happened in Group I than those in Group C（P0.05）.The operation condition in Group I was significantly superior to the Group C（P0.05）,and the operating time in Group C was significantly shorter than that in Group C（P0.05）.All patients of group I waked up 3-8 minute of post-operative,intra-operative satisfication and patient satisfication were both higher in group I than those in group T.Conclusion Controlled ventilation with laryngeal mask airway i-gel can have more stable hemodynamics and effective control on ventilation of patients,and can overcome the inhibition of respiratory problems,have significant improvement in microscopic examination conditions,wake up faster.