喉罩通气全身麻醉在纤维支气管镜氩气刀 治疗中心气道疾病中的临床应用

Clinical application of laryngeal mask airway ventilation under general anesthesia fibrobronehoscope with argon plasma coagulation in treating central airway diseases

摘要:

目的 评价喉罩通气（LMA）全身麻醉在纤维支气管镜（纤支镜）氩气刀治疗中心气道疾病中的应用效果和可行性。 方法 回顾分析2009年1月~2013年7月，LMA下纤支镜氩气刀治疗的21例中心气道疾病患者的临床和手术资料，从入室起持续监测收缩压（SP）、舒张压（DP）、心率（HR）和脉搏氧饱和度（SPO2），记录麻醉前（T1）、手术中（T2）和术毕（T3）时的SP、DP、HR和SPO2，记录置入喉罩后（P1）、经喉罩置入纤支镜即刻（P2）、拔出纤支镜即刻（P3）的气道压力峰值，统计手术时间、通气时间、呼吸恢复时间、清醒时间、拔管时间和并发症情况。 结果 21例患者共实施了32例次LMA下纤支镜氩气刀手术。一次性成功置入喉罩30例次，另外2例次更换型号后成功置入。该组麻醉效果满意，术程顺利，手术时间为15～50（23.5±10.6） min，通气时间25～60（32.5±12.8）min，术中血压、心率等生命指征平稳，吸气气道压力峰值波动小，未发生气道并发症。 结论 喉罩通气全身麻醉下行纤维支气管镜氩气刀治疗中心气道疾病安全可行，血流动力学平稳，吸气气道压力峰值波动小，苏醒时间快，气道并发症少。

Abstract:

【Objective】 To evaluate the efficacy and safety of laryngeal mask airway ventilation under general anesthesia fibrobronehoscope with argon plasma coagulation in treating central airway diseases. 【Methods】 21 patients with central airway diseases were treated by fibrobronchoscope with argon plasma coagulation laryngeal under mask airway ventilation and general anesthesia. SP, DP, HR and SPO2 were continuously monitored during anesthesia and measured at 5 min after entering the surgery room (T1), during fibrobronchoscope (T2) and at the immediately after the bronchoscope extubating the glottis (T3). The peak values of airway pressure after inserting laryngeal mask／tracheal catheter (P1), immediately after inserting fiberoptic bronchoscope (P2) and immediately after extraction of fiberoptic bronchoscope (P3) were recorded. The operation time, ventilation time, breathing recovery time, wake time and extubation time were measured. The complications were observed in all patients during and after operation. 【Results】 21 patients received 32 argon plasma coagulation procedures. The operation time was 15~50 min and the ventilation time was 25~60 min. SP, DP, HR and SPO2 were steady during the operation. The peak values of airway pressure were not statistically significant (P >0.05). No complications were observed in all cases during and after operation. 【Conclusion】 The laryngeal mask airway ventilation under general anesthesia fibrobronehoscope with argon plasma coagulation in treating central airway diseases is efficacious and safe. This method is easy to keep stablehemodynamics and reduces the fluctuation range of the peak inspiratory airway pressure with steady and rapid recovery and less complications of airway.