输尿管软镜术中应用喉罩同步间歇指令通气的通气效果观察

目的评价输尿管软镜术中应用喉罩同步间歇指令通气（SIMV）的通气效果。方法选择2013年6月至9月广州医科大学附属第一医院泌尿外科收治的拟在输尿管软镜下行钬激光碎石术的肾结石患者30例，美国麻醉医师协会（ASA）分级I～Ⅱ级。使用丙泊芬、舒芬太尼麻醉诱导，手控辅助呼吸至患者自主呼吸消失，置入喉罩，连接麻醉机行SIMV。手术结束继续应用SIMV至患者呼吸恢复良好。记录麻醉前（T1）、喉罩置入后通气5min（T2）、手术结束（T3）和拔除喉罩患者自主呼吸5min（T4）4个时点的脉搏血氧饱和度（SpO2）、动脉血氧分压（PaO2）、动脉血二氧化碳分压（PaC02）和pH值，记录T2和T3时点气道峰压（P_peak）、分钟通气量（MV）、动态顺应性（C_dyn）、呼气末二氧化碳分压（PETC02）和压力一容量环（P-V环）、P_ETCO2波形。结果4个时点的PaO2、PaCO2、pH值和SpO2均在正常范围。他和，13时点的PaO2明显高于T1和T4时点（均P〈0．05）。术中行喉罩SIMV时，T2和T3时点的P_peak、MV、C_dyn、PETCO2差异无统计学意义（均P〉0．05），P-V环和P_ETCO2波形无改变。结论全身麻醉下输尿管软镜术中应用喉罩SIMV能保持良好的通气效果。

Ventilation efficiency of synchronized intermittent mandatory ventilation via a laryngeal mask airway during flexible ureteroscopy

Objective To evaluate the ventilation efficiency of synchronized intermittent mandatory ventilation （SIMV） via a laryngeal mask airway during flexible ureteroscopy. Methods Thirty kidney stone patients scheduled for holmium laser lithotripsy under flexible ureteroscopy from Department of Urinary Surgery, The First Affiliated Hospital, Guangzhou Medical University between June 2013 and September 2013 were enrolled. The patients were rated as grades I-Ⅱ according to American Society of Anesthesiologists （ASA）. General anesthesia was induced with propofol and sufentanil, and the patient was ventilated by manual assisted maneuver till cease of spontaneous respiration, then a laryngeal mask airway was placed and connected to the anesthesia apparatus for SIMV. SIMV was continuously applied throughout the operation until patients had good respiratory recovery. Pulse oxygen saturation （SpO2）, arterial partial pressure of oxygen （PaO2）, arterial partial pressure of carbon dioxide （PaCO2） and pH value were recorded at 4 time points： immediately prior to anesthesia （T1）, 5 min after laryngeal mask airway ventilation （T2）, immediately after procedure （T3） and 5 min after laryngeal mask airway removal and recovery of spontaneous respiration （T4）. Peak airway pressure （P_peak）, minute volume （MV）, dynamic compliance （C_dyn）, end-tidal pressure of carbon dioxide （P_ETCO2）, pressure-volume ring （P-V ring） and P_ETCO2 waveform at T2 and T3 time points were also recorded. Results PaO2, PaCO2, pH value and SpO2 at all 4 time points were within normal range. PaO2 at T2 and T3 were apparently higher than those at T1 and T4 （all P〈0.05）. During SIMV via laryngeal mask airway in the operation, there was no statistical difference in P_peak, MV, C_dyn and P_ETO2 between T2 and T3 （all P 〉 0.05）, and there was no obvious change in P-V ring and PETC02 waveform also. Conclusion SIMV via a laryngeal mask airway is effective for maintenance of favorable ventilation during