依据气道峰压设置喉罩套囊内压的临床效果

Effect of the setting of laryngeal mask airway intracuff pressure based on airway peak pressure

中文关键词: 喉罩  压力  气道管理  腹腔镜

英文关键词: Laryngeal mask airway  Pressure  Airway management  Laparoscopy

中文摘要:

      目的 观察全麻喉罩通气过程中能封闭气道的最小套囊内压（intracuff pressure,ICP）设置的效果。方法 全麻下择期行妇科腹腔镜手术患者60例,年龄18～65岁，ASA Ⅰ或Ⅱ级,随机分为压力调控组(P组)和对照组(C组),每组30例。全麻诱导后插入4号Supreme喉罩,向套囊内注入空气,使ICP达60 cm H₂O。行容量控制通气,记录气道峰压(peak pressure, Ppeak)。P组将喉罩套囊内气体抽净后,向套囊内充气至ICP达Ppeak水平,如漏气,每次增加5 cm H₂O,直至无气体从口咽部漏出。气腹建立后,P组套囊充气恢复至60 cm H₂O,再次记录Ppeak后重复以上操作,并以此作为封闭气道的最小ICP直至手术结束。C组ICP保持为60 cm H₂O。记录气腹前和气腹后Ppeak、ICP和套囊充气容量;测定呼气相和吸气相ICP;记录吸气VT(VTi)和呼气VT(VTe),计算漏气率=［(VTi-VTe)/VTi×100％］;记录术后24 h咽喉部并发症情况。结果 与C组比较,P组在气腹前和气腹后呼气相和吸气相ICP均明显降低(P＜0.05)。气腹前和气腹后P组套囊充气容量明显低于C组（P＜0.05）。与气腹前比较，气腹后两组漏气率均明显升高（P＜0.05）。与C组比较,P组术后咽喉痛及吞咽不适的发生率明显降低(P＜0.05)。结论 全麻喉罩通气过程中将ICP设置在Ppeak+0～5 cm H₂O,可产生良好的密封效果,且可减少咽喉部并发症的发生。

英文摘要:

      Objective To explore the effects of airway peak pressure (Ppeak) guidance on the minimum laryngeal mask airway (LMA) intracuff pressure (ICP) setting during general anesthesia. Methods Sixty patients, aged 18-65 years, ASA physical status Ⅰ or Ⅱ, scheduled for elective gynecological laparoscopic operation under general anesthesia were enrolled. The patients were randomly divided into pressure-regulated group (group P) and control group (group C) with 30 cases in each group. Size 4 Supreme LMA was inserted in after general anesthesia induction. Air was injected into the cuff to make ICP achieve 60 cm H₂O. Volume-controlled ventilation was selected and Ppeak was recorded. In group P, all the gas in the LMA cuff was sucked out, and then air was injected in during expiration phase to make ICP achieve the level of Ppeak. If air leakage occurred, ICP was increased by 5 cm H₂O each time until no gas leaked from the oropharynx. After pneumoperitoneum, the cuff was inflated to make ICP achieve 60 cm H₂O and Ppeak was recorded once more. Then all the gas in the LMA cuff was sucked out, and air was injected into the cuff to make ICP achieve the level of Ppeak as the above method till the end of operation. In group C, ICP was maintained at 60 cm H₂O. Ppeak, ICP and the intracuff gas volume were recorded before and after pneumoperitoneum. ICP during inspiratory phase in the two groups was measured. Tidal volume during inspiration (VTi) and expiration (VTe) in the two groups were recorded, and the air leakage fraction (LF) was calculated as ［(VTi-VTe)/VTi×100％］. Laryngopharyngeal complications of all the patients in 24 hours after surgeries were also recorded. Results The intracuff gas volume before and after pneumoperitoneum and ICP were decreased significantly in group P compared with group C (P＜0.05). There was no difference in LF between the two groups. Compared with group C, there were fewer patients with postoperative throat pain and swallow discomfort in group P (P＜0.05). Conclusion ICP at the level of Ppeak plus 0-5 cm H₂O during LMA ventilation can provide better sealing effect and less laryngopharyngeal complications.