CAJ | 학술논문

目的：探讨仰卧位与俯卧位喉罩套囊不同充气容积时气囊内压的变化。方法择期行腰椎手术的患者40例（男24例，女16例），年龄22～67岁，体重50～70 kg，BMI＜30 kg/m2， ASA分级Ⅰ～Ⅱ级。麻醉诱导后置入4号Supreme喉罩，分别测量仰卧位（A组）与俯卧位（B组）套囊充气容量范围为5～30 ml（每5 ml递增）时套囊内压及气道峰压并记录相对应的实际潮气量。记录喉罩拔出过程中恶心呕吐、呛咳、误吸、低氧血症和喉罩四周血迹程度的情况；术后24 h内患者咽喉疼痛、声音嘶哑、吞咽困难等发生情况。结果充入相同容量的气体时，A 组的气道峰压和气囊内压要明显低于B组（P＜0.05）。仰卧位套囊充气容量为15～25 ml时，气囊内压为（23.5±3.1）～（46.3±4.5）cmH2O，有92.5%～100%的患者实际潮气量达到90%设定潮气量；充气容量为30 ml时，气囊内压为（64.5±5.5）cmH2O，大于推荐的60 cmH2O气囊内压。俯卧位套囊充气容量为15～20 ml时，气囊内压为（31.8±3.7）～（50.2±3.0）cmH2O，有95%～100%的患者实际潮气量达到90%设定潮气量；充气容量为25 ml时，气囊内压为（67.0±6.6）cmH2O，大于推荐的60 cmH2O。喉罩拔出过程中所有患者均未发生恶心呕吐、呛咳、误吸，有1例拔出喉罩后有低氧血症，有2例拔出喉罩后，喉罩带血；术后24 h所有患者均未有声音嘶哑及吞咽困难，有1例术后有咽喉疼痛。结论俯卧位喉罩所需的充气容量明显减少，且在相同充气容积时俯卧位的囊内压明显高于仰卧位，在临床工作中需根据实际体位选择最合适的充气容量。
목적：탐토앙와위여부와위후조투낭불동충기용적시기낭내압적변화。방법택기행요추수술적환자40례（남24례，녀16례），년령22～67세，체중50～70 kg，BMI＜30 kg/m2， ASA분급Ⅰ～Ⅱ급。마취유도후치입4호Supreme후조，분별측량앙와위（A조）여부와위（B조）투낭충기용량범위위5～30 ml（매5 ml체증）시투낭내압급기도봉압병기록상대응적실제조기량。기록후조발출과정중악심구토、창해、오흡、저양혈증화후조사주혈적정도적정황；술후24 h내환자인후동통、성음시아、탄인곤난등발생정황。결과충입상동용량적기체시，A 조적기도봉압화기낭내압요명현저우B조（P＜0.05）。앙와위투낭충기용량위15～25 ml시，기낭내압위（23.5±3.1）～（46.3±4.5）cmH2O，유92.5%～100%적환자실제조기량체도90%설정조기량；충기용량위30 ml시，기낭내압위（64.5±5.5）cmH2O，대우추천적60 cmH2O기낭내압。부와위투낭충기용량위15～20 ml시，기낭내압위（31.8±3.7）～（50.2±3.0）cmH2O，유95%～100%적환자실제조기량체도90%설정조기량；충기용량위25 ml시，기낭내압위（67.0±6.6）cmH2O，대우추천적60 cmH2O。후조발출과정중소유환자균미발생악심구토、창해、오흡，유1례발출후조후유저양혈증，유2례발출후조후，후조대혈；술후24 h소유환자균미유성음시아급탄인곤난，유1례술후유인후동통。결론부와위후조소수적충기용량명현감소，차재상동충기용적시부와위적낭내압명현고우앙와위，재림상공작중수근거실제체위선택최합괄적충기용량。
Objective To explore the intracuff pressure (ICP) of a laryngeal mask airway (LMA) with different cuff volume both in the prone positions and in the supine position. Methods Forty (male 24, female 16) ASA Ⅰ-Ⅱ patients, aged 22 to 67, weighing 50-70 kg, BMI<30 kg/m2, scheduled for elective lumbar surgery, were included in the study. General anesthesia was induced and then a size 4 deflated LMA was inserted. Measured the intracuff pressure and airway peak pressure of LMA inflated with 5-30 ml (on the increase of 5 ml) of air both in supine (group A) and prone (group B) position and then recorded the corresponded actual tidal volume (Vat). Nausea & vomiting, choking, aspiration, hypoxemia and the extent of blood around the laryngeal mask were noted, alongside with sore throat, hoarseness, difficulty swallowing within 24 hours after surgery. Results Inflated with the same volume of air, both airway peak pressure and ICP in group A were lower than those in group B (P<0.05). In group A, when cuff volume was 15-25 ml, ICP was (23.5±3.1)-(46.3±4.5)cmH2O and actual tidal volume of 92.5%-100% patients reached 90% set tidal volume; when cuff volume was 30ml, ICP was (64.5±5.5) cmH2O and more than recommended 60 cmH2O. In group B When cuff volume was 15-20 ml, ICP was (31.8±3.7)-(50.2±3.0)cmH2O and actual tidal volume of 95%-100%patients reached 90%set tidal volume;when cuff volume was 25 ml, ICP was (67.0±6.6)cmH2O and more than recommended 60 cmH2O. During removing the LMA, all patients had no nausea and vomiting, choking, and aspiration, there was one case of hypoxia and two cases with blood staining on the LMA after its removal;all patients were no dysphonia and dysphagia and one case of postoperative sore throat pain 24 hours after operation. Conclusion The cuff volume is significantly reduced in prone position, the intracuff volume is obviously higher in prone position than that in supine position with the same cuff volume. It is needed to select the most appropriate cuff volume in the clinical work according to the actual position.