【作者】 王玉；

【导师】 田悦；

【作者基本信息】 中国医科大学 ， 麻醉学（专业学位）， 2023， 硕士

【摘要】 目的:探讨两种不同的头颈位置是否会对Guardian喉罩的正压通气效果及术后不良反应产生影响。研究方法:本研究选取了于2021年8月至2022年6月择期全麻下行腹腔镜中短时长手术的患者78例,按照随机数字表法将患者随机分为头颈俯屈位组（Ⅰ组）与正中位组（Ⅱ组）。所有患者均于常规麻醉诱导后由同一位麻醉医师置入Guardian喉罩,采用容量控制通气,分别于头颈俯屈位与正中位记录患者的声门显露分级和喉罩的密封压,记录完上述两项数据后,将患者的头颈位置按照组别摆放,直至手术结束。分别于置入喉罩后（T_a）、拔出喉罩前（T_b）,应用超声探头测量患者胃窦部的前后径（D₁）和头尾径（D₂）,利用公式计算出T_a与T_b时的胃窦部横截面积,从而计算出上述两个时间点的胃窦部横截面积之差（ΔCSA）,以评估患者是否发生胃胀气。其他次要指标包括:气腹前（T₁）、气腹5min后（T₂）、气腹20min后（T₃）、关闭气腹5min后（T₄）的呼气末二氧化碳（Pet CO₂）、气道峰压（Ppeak）、潮气量（Vt）等呼吸参数;记录术中通气评分,术中手法调整喉罩的次数,喉罩的置入次数以及置入时的难易度;记录拔除喉罩时罩体表面带血、返流、喉痉挛,术后24小时内发生咽痛、咳嗽、声音嘶哑、吞咽困难等不良反应的病例数。结果:与头颈正中位相比,俯屈位下的喉罩密封压力明显增大,气道密封性显著增高（P<0.05）;俯屈位组二氧化碳气腹后（T₂、T₃）的Ppeak明显高于正中位组（P<0.05）;俯屈位组出现喉罩带血、咽痛的概率高于正中位组（P<0.05）;两组患者的一般资料、声门显露等级、ΔCSA、术中通气评分、喉罩置入和调整情况、术后24小时内发生的不良反应均无统计学差异（P>0.05）。结论:在使用Guardian喉罩进行正压通气时,头颈俯屈位虽然可以增加Guardian喉罩的密封性,但通气阻力与患者口咽黏膜出血的风险亦会增加。在全麻术中,麻醉医师应慎将患者头颈位置调整为俯屈位。更多还原

【Abstract】 Objective:To explore whether different head and neck positions have an effect on the effectiveness of positive pressure ventilation and postoperative adverse effects of the Guardian laryngeal mask.Methods:In this study,seventy-eight patients who underwent laparoscopic surgery under elective general anesthesia from August 2021 to June 2022 were selected,and the patients were randomly divided into head and neck flexion group（GroupⅠ）and neutral group（GroupⅡ）according to the random number table method.An Guardian laryngeal mask was placed in all patients,and mechanical ventilation was performed using a volume-controlled mode.The patient’s vocal fold grading and laryngeal mask seal pressure will be recorded in flexion and neutral position respectively,and after recording these two data,the patient’s head and neck position will be placed according to the group until the end of the surgery.After the mask was placed（T_a）and before the mask was removed（T_b）,the anteroposterior diameter（D₁）and the cephalocaudal diameter（D₂）of the gastric sinus were measured with an ultrasound probe,and the difference between the cross-sectional area of the gastric sinus（ΔCSA）at Ta and Tb was calculated by applying the formula for the cross-sectional area of the gastric sinus.Other secondary indicators included respiratory parameters such as end-expiratory carbon dioxide（Pet CO₂）,peak airway pressure（Ppeak）,and tidal volume（Vt）were recorded before pneumoperitoneum（T₁）,5 minutes after pneumoperitoneum（T₂）,20 minutes after pneumoperitoneum（T₃）,and 5 minutes after pneumoperitoneum was closed（T₄）;The intraoperative ventilation score,the number of manual adjustment of laryngeal mask,the number of laryngeal mask placement and the difficulty of insertion were recorded;the number of cases with blood on the mask surface after removal of the mask,reflux,aspiration and the number of adverse reactions such as sore throat,cough,hoarseness,dysphagia 24 hours after surgery.Results:Compared with the neutral position,the mask seal pressure was significantly higher in the flexion position,and the airway sealability was significantly higher（P<0.05）.Ppeak after carbon dioxide pneumoperitoneum（T2,T3）was significantly higher in the flexion group than in the neutral group（P<0.05）.The rate of blood in the mask and sore throat was significantly higher in the flexion group than in the neutral group（P<0.05）,and there was no statistically significant difference between the two groups in terms of vocal fold grading,ΔCSA,ventilation score,laryngeal mask insertion and adjustment,adverse reactions occurring within 24 hours after surgery（P>0.05）.Conclusion:When using Guardian laryngeal mask for positive pressure ventilation,the head and neck bent position can enhance the seal of the mask,but at the same time,it may increase the patient’s resistance to ventilation and the risk of oropharyngeal mucosal bleedingthe.During general anaesthetic surgery,the anaesthetist should carefully adjust the patient’s head and neck position to a flexed position.更多还原