纤维支气管镜联合超声定位喉罩在老年全身麻醉患者气道管理中的应用*

Application of bronchofiberscope combined with ultrasonic positioning laryngeal mask in airway management of aged patients under general anesthesia*

摘要:

比较可视化技术定位喉罩插管和气管插管应用于老年全身麻醉患者的临床效果。方法 80例老年全麻患者，美国麻醉医师协会分级（ASA）Ⅰ～Ⅲ级，随机分为两组，A组40例（气管插管组）；B组40例（可视化定位喉罩组）。分别记录入室安静后5 min时（T0）、气管导管插入（喉罩）前即刻（T1）、插入后即刻（T2）、插入后3 min（T3）、拔除时（T4）、拔除后即刻（T5）、拔除后3 min（T6）的平均动脉压（MAP）及心率（HR）的变化以及术后患者咽喉痛等并发症的发生率，观察和记录两组患者苏醒期呛咳、术后早期呕吐恶心、咽痛和声嘶等并发症情况并比较。结果 A组和B组皆能安全的完成手术，B组术中置入和拔除喉罩前后的MAP和HR无明显变化（P >0.05）；A组拔除气管导管前后的MAP和HR有明显变化，较B组明显升高（P <0.05）。B组拔除喉罩时患者的呛咳、呕吐恶心以及术后咽喉痛的发生明显少于A组（P <0.05）。结论 老年全麻患者使用超声联合纤支镜定位喉罩管理气道是安全可行的，与气管插管比较具有操作简单、血液动力学平稳和并发症少等优点，适合老年人手术全麻气道管理的应用。

Abstract:

Abstract: Objective To compare the clinical effects of visual technological intubation with positioning laryngeal mask and tracheal intubation for the patients under general anesthesia. Method This test contains 80 aged patients under general anesthesia, with ASA I~III, randomly divided into two groups, 40 patients in A group named tracheal intubation group, and the other 40 patients in B group named laryngeal mask group. Relatively record the MAP and HR changes when 5 minutes after enter in operating room and keep quiet (T0), before immediate insert into (laryngeal mask) with tracheal catheter (T1), immediate insert (T2), 3 minutes after insert (T3), removing time (T4), immediate time after remove (T5), 3 minutes after remove (T6), and the occurrence rate of postoperative complications like pharyngalgia etc. Then observe and record the complications like bucking during emergence period, nausea, vomiting, pharyngalgia and hoarseness etc in the early postoperative period and make comparison. Result The patients in A Group and B Group all accept safe operations, there is no obvious changes about MAP and HR before and after the insert and remove laryngeal mask in B Group (P > 0.05); and there is obvious changes about MAP and HR before and after remove tracheal catheter in A Group (P < 0.05), and obviously increased than B Group (P < 0.05). In B Group, the occurrence rate of bucking, nausea, vomiting, and pharyngalgia after operation is obvious less than that in A Group (P < 0.05). Conclusion The application of ultrasonic combined with bronchofiberscope positioning laryngeal mask in airway management of aged patients under general anesthesia is safety and workable. And comparing with tracheal intubation, it has simple operation, smooth and steady hemodynamics and less complications, which is fit for the application of aged patients’ airway management under general anesthesia.