CAJ | 학술논문

目的：比较喉罩与面罩通气方式用于老年患者纤维支气管镜（纤支镜）检查术的效果。方法：120例ASAⅠ～Ⅲ级的老年患者，根据通气方式的不同随机分为表面麻醉自主呼吸组（Ⅰ组，n＝40）、内镜面罩通气组（Ⅱ组，n＝40）和喉罩通气组（Ⅲ组，n＝40），其中Ⅰ组经鼻导管吸氧、Ⅱ组通过内镜面罩供氧、Ⅲ组插入喉罩控制呼吸。观察术中通气效果、不良反应，记录患者纤支镜检查前、中、后的心率（HR）、平均血压（MAP）、血氧饱和度（SpO2）、血浆去甲肾上腺素的变化以及患者和镜检医师满意度。结果：与Ⅰ组比较，Ⅱ组和Ⅲ组手术条件好，不良反应少，检查中 MAP、HR 和 NE 波动变化小，手术耗时短，完成度高，患者术后满意度高，差异有统计学意义（P＜0．01或 P＜0．05）；Ⅱ组呼吸抑制、呼吸道梗阻发生率、手术耗时高于Ⅲ组（P＜0．05）。结论：面罩和喉罩均可安全用于老年人全身麻醉下支气管镜检查术气道管理，后者具有通气可靠、血流动力学平稳和便利的优势，值得临床推荐。
목적：비교후조여면조통기방식용우노년환자섬유지기관경（섬지경）검사술적효과。방법：120례ASAⅠ～Ⅲ급적노년환자，근거통기방식적불동수궤분위표면마취자주호흡조（Ⅰ조，n＝40）、내경면조통기조（Ⅱ조，n＝40）화후조통기조（Ⅲ조，n＝40），기중Ⅰ조경비도관흡양、Ⅱ조통과내경면조공양、Ⅲ조삽입후조공제호흡。관찰술중통기효과、불량반응，기록환자섬지경검사전、중、후적심솔（HR）、평균혈압（MAP）、혈양포화도（SpO2）、혈장거갑신상선소적변화이급환자화경검의사만의도。결과：여Ⅰ조비교，Ⅱ조화Ⅲ조수술조건호，불량반응소，검사중 MAP、HR 화 NE 파동변화소，수술모시단，완성도고，환자술후만의도고，차이유통계학의의（P＜0．01혹 P＜0．05）；Ⅱ조호흡억제、호흡도경조발생솔、수술모시고우Ⅲ조（P＜0．05）。결론：면조화후조균가안전용우노년인전신마취하지기관경검사술기도관리，후자구유통기가고、혈류동역학평은화편리적우세，치득림상추천。
Objective To evaluate the different effects of laryngeal mask and mask ventilation during bronchoscopy in elder patients. Methods 120 old patients (ASA I-III) were divided into three group according to the table of random number as following:surface anesthesia with autonomous respiration (group I);endoscope mask ventilation (group II);laryngeal mask airway ventilation (group III). Oxygen inhalation through nasal tube in groupⅠ,group II and group III was ventilated with endoscope mask and LMA respectively ,thenwe observed whether there were adverse effects or not during the procedure. Results The adverse reactions of group I were more than other groups. Compared with the group I, variance of MAP,HR, RR, SpO2 in the groupⅡand groupⅢ had less changes, the cases with severe bucking decreased significantly, and satisfaction degree increased markedly, (P <0.01or P<0.05 ) . The incidence rate of resp iratory depression and airway obstruction in groupⅡwas higher than that in groupⅢ (P<0.05). Conclusion Endoscope mask ventilation and LMA can both be adopted in analgesia bronchoscopy for old patient. LMA under general anesthesia to transbronchial lung biopsy would control respiration according to the demand at any time.LMA has more advantage in the operation for the stable respiration and hemodynamics and less complications.