腰椎手术患者俯卧位应用 ProSeal 喉罩进行气道管理的效果观 察简

目的 观察腰椎手术患者俯卧位应用ProSeal喉罩进行气道管理的效果.方法 选择2011年2～9月解放军总医院单间隙椎间盘突出或腰椎滑脱患者40例,均为美国麻醉师协会（ASA） Ⅰ～Ⅱ级,随机分为喉罩组（P组,20例）和气管内插管组（T组,20例）.记录患者翻身前后气道压峰值变化,手术开始时及手术结束缝皮前呼气末二氧化碳（PetCO2）及二氧化碳分压（PaCO2）,术中血氧饱和度,以及与喉罩置入或气管内插管相关咽喉部不良反应.结果 所有患者仰卧位均成功完成气管内插管或喉罩置入,改俯卧位后均成功完成麻醉与预期手术操作.与仰卧位IT组：（16.5±3.6）mm Hg,P组：（18.9±4.5）mm Hg]相比,俯卧位P组及T组患者气道压峰值明显升高[T组：（15.0±2.0）mm Hg,P组：（17.3±2.2）mm Hg],差异有高度统计学意义（P＜0.01）.两组患者手术开始及手术结束缝皮前PaCO2均明显高于PetCO2,差异有高度统计学意义（P＜ 0.01）,但手术前后及两组间PetCO2及PaCO2差异无统计学意义（P＞0.05）.P组有3例在翻身后出现轻度漏气,术中有3例出现轻度漏气,经位置调整及麻醉深度调节后机械通气效果改善.术后恢复期间P组有3例、T组有7例出现轻度以上躁动.P组和T组各有2例和4例发生术后咽疼.结论 ProSeal喉罩用于短时间（＜4 h）俯卧位气道管理是可行的.与气管内插管相比,喉罩通气具有相似的通气效果,且相关咽喉部不良反应少.

Efficacy of applying ProSeal laryngeal mask airway during lumbar surgery in prone position

Objective To study the efficacy of applying ProSeal laryngeal mask airway （PLMA） during lumbar surgery anesthetized in prone position.Methods 40 single-lumbar disc herniation or spinal stenosis patients from February to September 2011 in General Hospital of PLA,ASA Ⅰ-Ⅱ,undergoing surgery in prone position were selected and divided into ProSeal laryngeal mask airway insertion group （group P,20 cases） or intra-tracheal intubation group （group T,20 cases） in supine position.The peak airway pressure in supine position and prone position,PetCO2 and PaCO2 at the beginning of operation and before incision closure,the intubation corresponding adverse reactions were compared.Results The intra-tracheal intubation and laryngeal mask airway insertion were succeeded and the anesthesia and operation went smoothly in all patients.During mechanical ventilation,the patients＇ peak airway pressure in supine position [group T：（16.5±3.6） mm Hg,group P：（18.9±4.5） mm Hg] were increased significantly than those in prone position [group T：（15.0±2.0） mm Hg,group P：（17.3±2.2） mm Hg],the differences were statistically significant （P 〈 0.01）.PaCO2 of both groups were much higher than PetCO2 at the beginning and in the end of operation,before finishing suturing skin,the differences were statistically significant （P 〈 0.01）.However,PaCO2 at the beginning of operation were compared with that in the end of operation in the same group or different group,the difference were not statistically significant （P 〉 0.05）.When patients turned over from supine position to prone position,3 cases of airway were leakage in group P,in addition,3 cases of airway were leakage in group P during mechanical ventilation.The airway leakage was adjusted by relocation the LMA position or deepen the anesthesia.The restlessness happened in 3 cases in group P and 7 cases in group T during recovery.Sore throat was present in 2 cases in group P vs 4 cases in group T respectively.Conclusion The results show that airway management with ProSeal LMA during short time （〈4 h） operation in prone position is feasible.Compared with endotracheal intubation,airway management with ProSeal LMA has the same ventilation effects and less intubating corresponding adverse reactions.