下颌托起支撑器与口咽通气道通气在肥胖患者全麻恢复期的应用

目的:比较下颌托起支撑器通气与口咽通气道通气在肥胖患者全麻恢复期优化气道管理的效果。方法:纳入择期全麻术后肥胖患者40例,随机分为下颌托起支撑器组(A组)和口咽通气道组(B组)各20例。在术后恢复室,患者呼吸恢复后拔除气管导管,A组患者使用下颌托起支撑器通气,B组经口腔置入口咽通气道通气;2组患者均以面罩给氧(氧流量2 L／min)至苏醒,当2组患者的血氧饱和度(SpO2)1),采取不同通气方式后5 min(T2)、10 min(T3)、20 min(T4)时SpO2、呼吸频率(RR)、平均动脉压(MAP)和心率(HR)变化情况,并记录躁动、恶心呕吐、喉痉挛的发生情况。结果:2组患者SpO2、RR、MAP和HR维持在正常范围。A组患者SpO2在各时间点与B组差异均无统计学意义(P>0.05),A组患者HR在T2和T3均明显低于B组(P2、T3和T4均显著低于B组(PPP>0.05)。结论:下颌托起支撑器通气与口咽通气道通气在肥胖患者全麻恢复期的应用效果相同,下颌托起支撑器通气对患者生命体征影响较低,并发症较少。

The application of the jaw support and oropharyngeal airway ventilation in obese patients during the general anesthetic recovery

Objective:To compare the effects of the airway management between the jaw support ventilation and oropharyngeal airway ventilation in obese patients during the general anesthetic recovery. Methods:Forty obese patients scheduled by general anesthesia were randomly divided into the jaw support ventilation group(group A) and oropharyngeal airway ventilation group(group B)(20 cases each group) . The group A and B were treated with the jaw support ventilation and oral pharyngeal airway ventilation after tracheal extubation, respectively. Two groups were treated with mask oxygen inhalation(oxygen flow min/2L) until awaking,and the further measures were taken when the pulse oxygen saturation( SpO2 ) was less than 90%. The changes of SpO2 ,respiratory rate( RR) ,mean arterial pressure (MAP),heart rate(HR) were observed,and the occurrence of restlessness,nausea,vomiting and laryngospasm were recorded at the beginning of entering the postoperative recovery room ( T1 ) , after 5 min ( T2 ) , 10 min ( T3 ) , 20 min ( T4 ) of different modes of ventilation. Results:The levels of RR,MAP,HR and SpO2 were remained in the normal range. The differences of the SpO2 at each time-points between two groups were not statistically significant(P>0. 05). The HR in group A was significantly less than that in group B at T2 and T3(P<0. 01). The RR and MAP in group A were significantly less than that in group B at T2,T3 and T4(P<0. 01). The occurrence of restlessness in group A was less than that in group B(P<0. 05). The differences of the incidence of nausea,vomiting and laryngospasm between two groups were not statistically significant(P>0. 05). Conclusions:The application effects between the jaw support ventilation and oropharyngeal airway ventilation in obese patients during the general anesthetic recovery are same. The effects of the jaw support ventilation on the vital signs and its complication of patients are less.