CAJ | 학술논문

目的研制一种能讲话的声门外通气装置,以满足脑功能语言区手术中唤醒条件下监测、定位的需要,解决通气与讲话不能兼顾的难题.方法根据咽喉部解剖及通气和讲话原理研制成食道咽腔导管(Ⅰ型)、食道鼻咽腔导管(Ⅱ型)和带吸引导管的食道鼻咽腔导管(Ⅲ型).临床应用60例,其中妇科全麻手术40例,术毕患者清醒于拔管前让患者讲话；脑部语言区手术全麻术中唤醒20例,唤醒后发音.结果 60例患者插管顺利,术中通气良好,潮气量泄露＜56 ml,均低于20 cm H2O(1 cm H2O=0.098 kPa),血气正常,无二氧化碳蓄积及缺氧.患者清醒带管均能讲话,讲话的清晰度Ⅱ型和Ⅲ型导管显著优于Ⅰ型(P＜0.01).无严重并发症.结论 Ⅰ型、Ⅱ型和Ⅲ型导管,可安全实施全麻和机械通气,尤其是Ⅱ型和Ⅲ型通气效果满意,讲话清晰,患者易耐受,显著地提高了脑功能语言区手术麻醉的安全性和可控性.解决了语言功能术中唤醒麻醉带管讲话的难题.
목적 연제일충능강화적성문외통기장치,이만족뇌공능어언구수술중환성조건하감측、정위적수요,해결통기여강화불능겸고적난제.방법 근거인후부해부급통기화강화원리연제성식도인강도관(Ⅰ형)、식도비인강도관(Ⅱ형)화대흡인도관적식도비인강도관(Ⅲ형).림상응용60례,기중부과전마수술40례,술필환자청성우발관전양환자강화；뇌부어언구수술전마술중환성20례,환성후발음.결과 60례환자삽관순리,술중통기량호,조기량설로＜56 ml,균저우20 cm H2O(1 cm H2O=0.098 kPa),혈기정상,무이양화탄축적급결양.환자청성대관균능강화,강화적청석도Ⅱ형화Ⅲ형도관현저우우Ⅰ형(P＜0.01).무엄중병발증.결론 Ⅰ형、Ⅱ형화Ⅲ형도관,가안전실시전마화궤계통기,우기시Ⅱ형화Ⅲ형통기효과만의,강화청석,환자역내수,현저지제고료뇌공능어언구수술마취적안전성화가공성.해결료어언공능술중환성마취대관강화적난제.
Objective To design a series of extemalglottis breath catheters to solve the conflict between breath and sound production in wake-up patients during operation.Methods We have designed three model catheters,esophaguspharynx catheter (type Ⅰ),esophagusnasopharynx catheter (type Ⅱ),esophagusnasopharynx catheter with suction (type Ⅲ).These catheters were applied to 60 patients who were implemented general anesthesia.20 paitents were wake-uped during operation.Ruselts Intubation were successfully.All paitents had nice ventilation.Tidal volume leak was less than 56 ml,air passage pressure was under 20 cm H2O (1 cm H2O=0.098 kPa),and blood gas analysises were normal.All patients had not found carbon dioxide cumulation nor anoxia.All paitents could speak with catheter,the pronounce articulation of type Ⅱ and type Ⅲ were better than type Ⅰ (P＜0.01).Conclusions Patient can speak distinctly with these catheter in operation.The series of catheters can provide nice ventilation,which are safety under mechanical ventilation and general anesthesia.Type Ⅱ and type Ⅲ are better.These catheters solved the conflict between breath and sound production in wake-up patients during operation in intraoperation wake-up,and can enhance the safety of brain operation.