CAJ | 학술논문

目的：探讨三通喉罩在无痛纤维支气管镜检查中的安全性和可行性。方法：选择年龄65岁以下，ASAⅠ～Ⅱ级患者，按照自愿的原则分为静脉全麻组（IA）和局麻组（LA）。局麻组术前30 min肌注鲁米那100 mg+阿托品0.5 mg，检查前经环甲膜穿刺注射2%利多卡因3 mL做表麻。静脉全麻组静脉快速诱导后插入TLMA，插入成功后，TLMA标准端口连接麻醉机，纤支镜从直管带密封口置入进行检查、活检。记录麻醉前（T0）、纤支镜过声门即刻（T1）、纤支镜探查/活检时（T2）、术毕5 min（T3）各时间点的SBP、DBP、HR和SPO2；记录检查中发生低氧事件的情况、检查时间、苏醒时间。结果：19例无痛纤支镜顺利完成，患者术中循环平稳， SPO2变化于正常范围内，无呛咳、体动、低氧等不良事件，与局麻组比较差异有统计学意义（P＜0.05），静脉全麻组患者和内镜医师满意度高。结论：TLMA应用于无痛纤支镜检查安全可靠、效果满意，能同时满足麻醉医师和内镜医师对气道的管理需要，具有临床应用价值。
목적：탐토삼통후조재무통섬유지기관경검사중적안전성화가행성。방법：선택년령65세이하，ASAⅠ～Ⅱ급환자，안조자원적원칙분위정맥전마조（IA）화국마조（LA）。국마조술전30 min기주로미나100 mg+아탁품0.5 mg，검사전경배갑막천자주사2%리다잡인3 mL주표마。정맥전마조정맥쾌속유도후삽입TLMA，삽입성공후，TLMA표준단구련접마취궤，섬지경종직관대밀봉구치입진행검사、활검。기록마취전（T0）、섬지경과성문즉각（T1）、섬지경탐사/활검시（T2）、술필5 min（T3）각시간점적SBP、DBP、HR화SPO2；기록검사중발생저양사건적정황、검사시간、소성시간。결과：19례무통섬지경순리완성，환자술중순배평은， SPO2변화우정상범위내，무창해、체동、저양등불량사건，여국마조비교차이유통계학의의（P＜0.05），정맥전마조환자화내경의사만의도고。결론：TLMA응용우무통섬지경검사안전가고、효과만의，능동시만족마취의사화내경의사대기도적관리수요，구유림상응용개치。
Objective: To investigate the safety and feasibility of three-way laryngeal mask airway used in painless fibreoptic bronchoscopy. Methods: Patients aged under 65 years old and ASAⅠ~Ⅱ were divided into intravenous anesthesia group (IA,n=19)and local anesthesia group (LA,n=20)according to the principle of voluntary. Patients in group LA were intramuscular injection with luminal 100 mg and atropine 0.5 mg 30 minites before operation. Then 3 mL lidocaine was injected via cricothyroid membrane pre-operation. Patients in group IA were inserted with three-way laryngeal mask airway after rapid induction of anesthesia. SBP, DBP, HR, and SPO2 were recorded at the moments in pre-anesthesia(T0), fibreoptic bronchoscopy through the glottis(T1), perform a biopsy(T2), 5 minutes after-operation(T3). The hypoxic events, check time and wake time were recorded during operation. Results:All patients finished painless fibreoptic bronchoscopy successfully, had stable hamodynamics, no side effect and complications in any cases (P<0.05). In group IA, satisfaction from patients and endoscopic physicians was high. Conclusion:Three-way laryngeal mask airway under intravenous anesthesia in painless fibreoptic bronchoscopy is a simple and safe method. The use of TLMA can satisfy the anesthesiologist and endoscopic physicians to airway management needs at the same time. It may obtain the respiratory control power, guarantee good ventilation and oxygen supply, and considerably improve the safety of anesthesia.