【作者】 刘继； 李明星；

【Author】 LIU ji,LI ming xing Department of Anesthesiology,Shanghai Pulmonary Hospital,Shanghai.200433,China

【机构】 上海市肺科医院麻醉科；

【摘要】 目的:介绍一种新型改良喉罩在无痛纤支镜检查中的应用效果。方法:设计一种适用于纤支镜检查的新型改良喉罩。选择60例纤支镜检查的患者随机分为Ⅰ组(局麻组)、Ⅱ组(静脉全麻组)和Ⅲ组(静脉全麻加喉罩组)。Ⅰ组按照常规行表面麻醉后,进行纤支镜检查;Ⅱ组,给异丙酚和芬太尼麻醉诱导后进行纤支镜检查,保留自主呼吸,必要时面罩加压给氧;Ⅲ组给异丙酚、芬太尼和短效肌松剂,肌松后插入改良喉罩,纤支镜由喉罩的直管进入呼吸道进行检查,通过喉罩的侧管进行控制呼吸。分别于纤支镜检查前(T0)、纤支镜检查1分钟(T1)和检查结束(T2)这3个时点记录三组病人的SpO2、MAP和HR,记录纤支镜检查时间和不良反应,调查镜检医师和患者满意度。结果:Ⅰ组检查时有呛咳、憋气及体动等不良反应,HR增快,MAP明显升高,SpO2下降,与术前比较有显著性差异(P<0.05),与Ⅱ组和Ⅲ组比较有显著性差异P<0.05),镜检医师和患者的满意度较低。Ⅱ组有2例出现一过性SpO2低于90%;MAP和HR与术前比较.无显著性差异(P>0.05),部分患者有少许咳嗽;镜检医师和患者的满意度较高。Ⅲ组的SpO2、MAP和HR保持平稳,无咳嗽和体动等不良反应,患者和镜检医师满意度最高。3组纤支镜检查时间无显著差异(P>0.05)。结论:新型改良喉罩在无痛纤支镜检查中的应用,不但提高无痛纤支镜检查的安全性,而且使该检查方便、快捷,具有良好的应用价值。更多还原

【Abstract】 Objective To introduce a new type improved laryngeal mask and compare the efficacy and safety of it applied for bronchoscopy with intravenous anesthesia.Methods A new type improved laryngeal mask airway applicable to bronchoscopy with intravenous anesthesia was used in the study.Sixty ASAⅠorⅡpatients were randomized to 3 groups(n=20 each):groupⅠtopical anesthesia;groupⅡintravenous anesthesia and groupⅢintravenous anesthesia with the new type improved laryngeal mask airway.Topical anesthesia with 2%lidocaine was used in groupⅠ.In groupⅡandⅢ,fentanyl lug.kg-1 and propofol 1-1.5mg.kg-1 were given.In groupⅢ,scoline 1.5-2mg.kg-1 was given to provide muscle relaxation,then the new type modified laryngeal mask was inserted.The bronchoscopy was performed through the straight tube of the new type improved laryngeal mask and controlled respiration was carried out through the side tube of it. HR,MAP and SpO2 were continuously monitored and recorded before and during the bronchoscopy.The easiness of the bronchoscope entering the glottis,the patient’s cooperation and amnesia during bronchoscopy were also evaluated.Results In groupⅠ,MAP and HR increased significantly as the bronchoscopy passed the glottis compared to the baseline values(P<0.05) and were also significantly higher than in grou pⅡandⅢ(P<0.05).The bronchoscopy method with the modified laryngeal mask was much easier in groupⅡandⅢ. Conclusion The application of the new type of modified laryngeal mask in bronchoscopy with intravenous anesthesia can relief patients’ discomfort,avoid hemodynamic fluctuation and can provide better condition and safety for the examination.更多还原