食管引流型喉罩和经典型喉罩的临床应用对比观察

目的比较经典型喉罩（CLMA）和食管引流型喉罩（PLMA）在骨科全麻手术中的应用，为临床安全有效选择喉罩提供参考依据。方法选择ASA分级Ⅰ～Ⅱ级，拟在全身麻醉下择期行骨科手术的患者100例，年龄18—60岁，体重指数（BMI）18-30kg／m2，随机分为CLMA组和PLMA组，每组50例。PLMA组沿食管引流孔插入14号胃管，观察两组喉罩一次置入成功率，尝试时间，头位，漏气率，胃胀气情况，记录患者入室，置入喉罩前，置入喉罩后以及离室四个时间点的平均动脉压，心率，血氧饱和度，并在术后2h，12～24h两个时间点随访患者是否咽喉痛，下颌痛，恶心呕吐，吞咽困难，声音嘶哑。结果两组患者的一般资料没有显著差异。喉罩置入时间，一次成功率，插罩方法，术中漏气需调整例数，以及通气失败需更换气管插管的例数，两组相比较均无显著差异（P〉0．05），两组患者各时点生命体征组间比较差异无显著性（P〉0．05）。术中胃胀气以及插入喉罩时需调整头位为嗅花位的患者例数两组相比较，PLMA组明显低于CLMA组，有统计学差异（P〈0．05），术后随访各并发症发生率均无统计学差异（P〉0．05）。结论与经典型喉罩相比较，食管引流型喉罩的机械通气效果和密封性更好，置入喉罩时简单伸展位即可顺利操作，成功率更高。

Clinical Comparison and Observation of the Use of ProSeal Laryngeal Mask Airway and Classic Laryngeal Mask Airway

Objective To observe effectiveness of the PLMA and the CLMA in selective orthopedic surgery,providing a reference for clinical option of laryngeal mask.Methods One hundred ASA Ⅰ-Ⅱ patients aged 18- 60 years old,BMI 18 - 30kg/m2 undergoing selective orthopedic surgery in the supine position were enrolled in this study.The patients were randomly divided into two groups,PLMA group and CLMA group. PLMA group were all been inserted with 14th naso-gastric tube through the drained tube.First attempt success rate,insertion time,head position,leakage,gastric insutflation,mean arterial pressure,heart rate and oxygen saturation were recorded at four time points（entering room,before and after inserting LMA,leaving room）.The complications of sore throat,jaw pain,nausea and vomiting,dysphagia and hoarseness were recorded at 2 hours,12 - 24 hours after the surgery.Results There were no significant difference of two groups of patients in general the demographic data.There were no significant difference between PLMA group and CLMA group in several observed facts,which includes insertion time,first attempt success rate,operation methods,the number of patients requiring adjusted or intubated,vital signs,and the complications.However, when comparing the number of gastric insufflation and sniffing position,it is statistically different（P〈0.05）.Conelusion Compared with the classic laryngeal mask,the effects of mechanical ventilation and seal of the ProSeal laryngeal mask are better.The success rate of insertion operation at simple stretch position is also higher for PLMA.