纤维支气管镜在食管引流型喉罩中的定位作用

目的 探讨纤维支气管镜在食管引流型喉罩(PLMA)定位中的应用.方法 择期行非腹腔镜全身麻醉手术患者60例,ASA分级Ⅰ～Ⅱ级,按随机数字表法分为两组:直接置入组(A组)和纤维支气管镜定位组(B组),每组各30例.静脉麻醉快速诱导后置入PLMA,充气喉罩至囊内压为50 cm H2O(1 cm H2O=0.098 kPa),固定喉罩接麻醉机正压通气,测量气道密封压、间歇正压通气的气道峰压及潮气量.结果 两组患者置入PLMA后均获得良好的肺通气效果(脉搏血氧饱和度＞0.97,呼气末二氧化碳分压在正常范围),顺利完成手术.A组患者有5例通过第2次调整、1例通过第3次调整.B组患者都在纤维支气管镜定位下置入.B组气道密封压高于A组,气道峰压低于A组(P＜0.05).结论 纤维支气管镜的应用可有效提高PLMA放置位置的准确性,从而加强其与声门周围组织的密封性,改善肺的通气,增加PLMA使用的安全性.

The role of fiberoptic bronchoscopy in the positioning of ProSeal laryngeal mask airway

Objective To investigate the role of fiberoptic bronchoscopy (FOB) in the positioning of ProSeal laryngeal mask airway (PLMA). Methods Sixty ASA Ⅰ or Ⅱ patients undergoing general anesthesia using PLMA were randomly divided into two groups with 30 cases each: inserted PLMA group (group A)and FOB positioning group (group B). After the routine intravenous anesthesia induction,the PLMA inflated to an intracapsular pressure of 50 cm H2O (1 cm H2O =0.098 kPa) with the positive airway pressure by the anesthesia apparatus, the airway seal pressure, airway peak voltage of intermittent positive pressure ventilation and tidal volume were evaluated. Results Patients from two groups achieved adequate lung ventilation (SpO2 ＞0.97,PETCO2 was normal), the operations were all smooth. There were 5 cases adjusted the position two times,and 1 case adjusted 3 times. Patients in group B were all PLMA insertion under FOB and airway seal pressure was higher,but airway peak voltage was lower than in group A (P＜0.05). Conclusion FOB elevates accurate allocation of PLMA,enhances the isolated function from the surrounding tissue of glottis, improves the lung ventilation, and increases the safety of PLMA.