喉罩应用于困难气管内插管的临床观察

目的观察喉罩应用于困难气管内插管的临床效果。方法选择ASAⅠ～Ⅱ级、Cormack-LehaneⅢ～Ⅳ类、年龄25～65岁,拟行择期腹部手术的患者40例,随机分为喉罩组（L组,n=20）和气管导管组（E组,n=20）。常规静脉麻醉诱导后分别置入喉罩或插入气管导管。观察记录两组患者喉罩置入/气管内插管的次数及时间,喉罩置入或气管内插管时MAP、HR及SpO2的变化,以及操作时及术后的相关不良反应。结果 L组1次成功置入喉罩的例数明显多于E组1次成功完成气管内插管的例数（P〈0.05）;L组建立有效气道的时间明显较E组短（P〈0.05）;E组气管内插管时和气管内插管后5min的MAP及HR较诱导后显著升高（P〈0.05）;E组气管内插管时SpO2较诱导后显著降低（P〈0.05）;L组操作时发生口腔粘膜出血及术后发生咽喉疼痛的患者明显少于E组（P〈0.05）。结论喉罩通气是解决困难气管内插管有效的方法之一,具有安全、方便及快捷的特点。

Clinical observation of laryngeal mask airway in difficult endotracheal intubation

Objective To evaluate the clinical effectiveness of laryngeal mask airway in difficult endotracheal intubation.Methods Forty ASA Ⅰ～Ⅱ grade patients undergoing elective abdominal surgery,Cormack-Lehane Ⅲ～Ⅳ,aged 25-65 years,were randomly divided into laryngeal mask airway group（group L,n=20） and endotracheal tube group（group E,n=20）.Laryngeal mask airway and endotracheal tube was intubated in the patients in the two groups under vein induced anesthesia,respectively.The time and frequency of the insertion of laryngeal mask airway or endotracheal tube were observed.The mean arterial pressure（MAP）,heart rate（HR） and pulse oxygen saturation（SpO2） during insertion of laryngeal mask airway and tracheal intubation were recorded.Adverse reactions related to the operation were observed and investigated.Results The primary success cases in group L were significantly more than that in group E（P0.05）.The time of the effective airway establishment in group L was is shorter than that in group E（P0.05）.The MAP and HR during tracheal intubation markedly rised in group E,and SpO2 obviously decreased（P0.05）.However,no obvious changes happened in group L.The incidence of oral mucosa hemorrhage and throat irritation in group L was more lower than that in group E（P0.05）.Conclusion In this study,we conclude that laryngeal mask airway is safe,effective and convenient method to deal with difficult endotracheal intubation.