CAJ | 학술논문

目的探讨纤维支气管镜在食管引流型喉罩(PLMA)定位中的应用.方法择期行非腹腔镜全身麻醉手术患者60例,ASA分级Ⅰ～Ⅱ级,按随机数字表法分为两组:直接置入组(A组)和纤维支气管镜定位组(B组),每组各30例.静脉麻醉快速诱导后置入PLMA,充气喉罩至囊内压为50 cm H2O(1 cm H2O=0.098 kPa),固定喉罩接麻醉机正压通气,测量气道密封压、间歇正压通气的气道峰压及潮气量.结果两组患者置入PLMA后均获得良好的肺通气效果(脉搏血氧饱和度＞0.97,呼气末二氧化碳分压在正常范围),顺利完成手术.A组患者有5例通过第2次调整、1例通过第3次调整.B组患者都在纤维支气管镜定位下置入.B组气道密封压高于A组,气道峰压低于A组(P＜0.05).结论纤维支气管镜的应用可有效提高PLMA放置位置的准确性,从而加强其与声门周围组织的密封性,改善肺的通气,增加PLMA使用的安全性.
목적 탐토섬유지기관경재식관인류형후조(PLMA)정위중적응용.방법 택기행비복강경전신마취수술환자60례,ASA분급Ⅰ～Ⅱ급,안수궤수자표법분위량조:직접치입조(A조)화섬유지기관경정위조(B조),매조각30례.정맥마취쾌속유도후치입PLMA,충기후조지낭내압위50 cm H2O(1 cm H2O=0.098 kPa),고정후조접마취궤정압통기,측량기도밀봉압、간헐정압통기적기도봉압급조기량.결과 량조환자치입PLMA후균획득량호적폐통기효과(맥박혈양포화도＞0.97,호기말이양화탄분압재정상범위),순리완성수술.A조환자유5례통과제2차조정、1례통과제3차조정.B조환자도재섬유지기관경정위하치입.B조기도밀봉압고우A조,기도봉압저우A조(P＜0.05).결론 섬유지기관경적응용가유효제고PLMA방치위치적준학성,종이가강기여성문주위조직적밀봉성,개선폐적통기,증가PLMA사용적안전성.
Objective To investigate the role of fiberoptic bronchoscopy (FOB) in the positioning of ProSeal laryngeal mask airway (PLMA). Methods Sixty ASA Ⅰ or Ⅱ patients undergoing general anesthesia using PLMA were randomly divided into two groups with 30 cases each: inserted PLMA group (group A)and FOB positioning group (group B). After the routine intravenous anesthesia induction,the PLMA inflated to an intracapsular pressure of 50 cm H2O (1 cm H2O =0.098 kPa) with the positive airway pressure by the anesthesia apparatus, the airway seal pressure, airway peak voltage of intermittent positive pressure ventilation and tidal volume were evaluated. Results Patients from two groups achieved adequate lung ventilation (SpO2 ＞0.97,PETCO2 was normal), the operations were all smooth. There were 5 cases adjusted the position two times,and 1 case adjusted 3 times. Patients in group B were all PLMA insertion under FOB and airway seal pressure was higher,but airway peak voltage was lower than in group A (P＜0.05). Conclusion FOB elevates accurate allocation of PLMA,enhances the isolated function from the surrounding tissue of glottis, improves the lung ventilation, and increases the safety of PLMA.