食道引流型喉罩与可弯曲喉罩用于中耳炎手术患者气道管理的有效性和安全性比较

目的 采用前瞻性研究对比分析食道引流型喉罩与可弯曲喉罩用于中耳炎手术患者气道管理的有效性和安全性。方法 选择2019年6至12月间在复旦大学附属眼耳鼻喉科医院接受择期中耳炎手术患者130例，年龄18~65岁，ASA分级Ⅰ或Ⅱ级，采用随机数字表法分为食道引流型喉罩（proseal laryngeal mask airway，PLMA）组和可弯曲喉罩（flexible laryngeal mask airway，FLMA）组，每组65例。全麻诱导后，根据患者体重选择合适型号的喉罩，采用经典手指引导法置入喉罩，行机械通气。记录喉罩置入的放置时间、手术时间、苏醒时间、首次放置成功率及总体成功率，记录头颈正中位和侧头位漏气压、15 cm H₂O压力控制下的呼出潮气量，采用纤维支气管镜观察体位变换前后咽部解剖结构显露情况分级；记录复苏期间的并发症如咽痛、声嘶、呛咳、喉痉挛、胃胀气、恶心呕吐、软组织损伤、喉罩罩体有无血迹、返流误吸等。结果 PLMA放置时间显著短于FLMA（P=0.010 2），而两种喉罩的首次放置成功率和总体放置成功率的差异均无统计学意义。FLMA的侧头位潮气量显著低于正头位（P=0.020 7），且显著低于PLMA组侧头位（P=0.013 4）。无论正侧位，PLMA的漏气压均显著高于FLMA（正侧位P均<0.000 1），而FLMA由正头位改为侧头位后漏气压显著下降（P=0.0128）。纤支镜定位分级结果显示各组间差异均无统计学意义。两组患者苏醒时间差异无统计学意义。FLMA组患者苏醒后咽痛（P=0.022 6）和胃胀气（P=0.042 2）显著多于PLMA组，其余并发症两组间差异无统计学意义。结论 PLMA与FLMA均可应用于全身麻醉下中耳炎手术的气道管理，两者有效性和安全性相当。PLMA密封效果更好，在变换头位时，潮气量不易受影响，胃胀气发生率较低，但存在软组织损伤的风险。

Comparison of efficacy and safety of proseal laryngeal mask airway versus flexible laryngeal airway mask in patients during otitis media surgery

Objective To prospectively investigate and compare the effect of proseal laryngeal mask airway (PLMA) and flexible laryngeal mask airway (FLMA) during otitis media surgery. Methods One hundred and thirty patients of ASA Ⅰ or Ⅱ classification and 18-65 years old undergoing otitis media surgery from Jun. to Dec. 2019 were randomly divided into group P with PLMA and group F with FLAM.There were 65 cases in each group,respectively.After induction,a appropriate size of LMA was selected according to patient's weight,and the standard index finger-guided technique was used to insert the LMA.Then patients were ventilated mechanically.The first attempt and total success rate of inserting laryngeal mask,the intubation time,surgery time and wake time were recorded.Tidal volume at 15 cm H₂O and leakage pressure in patients with supine and lateral position were assessed.The scale of fiberoptic bronchoscopy was also recorded to show airway exposure under postural changes.Related complications such as sore throat,hoarseness,cough,laryngospasm,gaseous distention,nausea and vomiting,soft tissue injury,blood residue after pulling out the LMA,regurgitation and aspiration were analyzed. Results The placement time of group P was significantly shorter than that of group F (P=0.010 2).There was no significant difference in the first attemp success rate and the total success rate between the two groups.The tidal volume at the lateral position of group F was significantly lower than that at the supine position (P=0.020 7),and was significantly lower than that at the lateral possition of group P (P=0.013 4).The leakage pressure of group P was significantly higher than that of group F (at both supine and lateral position,P<0.000 1).However,the leakage pressure of group F decreased significantly after the supine position changed to the lateral position (P=0.012 8).The scale of fiberoptic bronchoscopy showed no significant difference between the two groups.We found no difference in recovery time between the two groups,and there were significantly more patients with sore throat (P=0.022 6) and gaseous distention (P=0.042 2) in group F compared with group P.There was no significant difference in other complications between the two groups. Conclusion PLMA and FLAM can both be used safely and effectively in patients duringing otitis media surgery with general anesthesia.Both of them can provide effective ventilation in supine and lateral position.PLMA is superior than FLMA in leak pressure.Moreover,when the head position changes,the tidal volume is less affected,and the incidence of gastric distention is lower,but soft tissue is more easily injured by using PLMA.