弹性橡胶探条引导双腔喉罩置入的临床效果

目的 观察弹性橡胶探条引导双腔喉罩置入的临床效果,并与传统的徒手置入法进行比较.方法 拟定仰卧位或侧卧下接受骨科四肢择期手术的全麻患者200例.计算机随机法分为A、B两组各100例,A组按照说明书辅助管芯置入双管喉罩,B组用弹性橡胶探条插入食管引流管,于喉镜明视下将探条前端置入食道,以其作为引导置入喉罩.记录患者基本情况,喉罩置入一次成功率、置入总时间以及尝试置入次数,操作后有无咽喉部损伤情况.纤支镜通过食管引流管确认位置正确,置入食道的难易程度由操作者以数字评分法评估（numerical rating scale,NRS）.结果 两组患者在一次成功率、置入时间以及尝试置入次数和喉罩置入并发症方面差异无统计学意义（P＞0.05）.根据纤支镜检查,A组对位良好率明显低于B组（P＜0.05）,而置入食道的难易程度评分则明显高于B组（P＜0.05）.结论 弹性橡胶探条辅助双管喉罩置入可以显著提高食管引流管与食道上括约肌开口的对位准确率,可在临床推广应用.

The clinical effect of insertion of Double lumen laryngeal mask guided by gum elastic bougie

Objective To investigative the clinical effect of insertion of Double lumen laryngeal mask guided by gum elastic bougie. Methods Two hundred patients with elective surgery of tong bone fractures of the limbs at supine or lateral position under general anesthesia were randomly allocated for PLMA insertion using the digital, or gum elastic bougie （GEB） - guided techniques. The digital techniques were performed according to the manufacturer＇s instructions with stylet. The GEB-guided technique involved priming the drain tube with the GEB, placed the GEB in the esophagus under direct vision, and inserted the PLMA with the GEB as a guide. The two groups of patients~ preoperative demo- graphic data, the first success rate of intubation, the time of intubation and attempt numbers of intubation, the intuba- tion-related complications were recorded, and insertion position of the PLMA by FOB though the drain tube was as- sessed. The degree of difficulty of putting into the esophagus for the operator was assessed by NRS （numerical rating scale）. Results There were not significantly difference between two groups in the first success rate of intubation, at- tempts of numbers of intubation, the time of intubation and short-term intubation-related complications （P~〉0.05）. By the FOB under direct vision, the accuracy rate of A group was worse than B group （P~0.05）, therefore NRS scores in A group were higher than B group（P%0.05）. Conclusion The GEB can significantly improve accuracy rate of the coun- terpoint of upper esophageal sphincter and esophageal drain tube.