SLIPA与普通喉罩在全麻气道管理中的比较.doc

SLIPA与普通喉罩在全麻气道管理中的比较卫生部北京医院麻醉科 100730段宏军 时胜男 左明章 【摘要】 目的 比较SLIPA和普通喉罩在全麻气道管理中的密封压、通气效果及并发症。 方法 60例在全麻下行择期乳腺肿物切除术患者，ASA或级，随机分为两组（n=30），SLIPA组（S组）和普通喉罩组（L组）。两组患者根据体重选择喉罩型号，徒手法置入。全麻诱导用药为丙泊酚23mg/kg、舒芬太尼0.2g/kg和维库溴铵0.1 mg/kg，维持用药为12%七氟醚和60%笑气。记录喉罩密封压及纤支镜检查评级；记录术中HR、*P、DBP、SpO2、呼气末二氧化碳分压（PETCO2）、气道峰压（PPeak）；记录拔出喉罩后罩内侧、背侧面有无污物，有无返流误吸、咽喉痛；记录手术时间、苏醒时间、拔出喉罩时间。 结果 密封压S组（23.64.7）cmH2O高于L组（18.84.5）cmH2O（P 0.05），纤支镜检查级S组和L组为19vs27例（P 0.05）。两组术中血流动力学平稳，SpO2、PETCO2、PPeak均在正常范围内。S组和L组罩内有少量分泌物为4vs2例、罩背侧面有血迹为5vs3例，S组和L组咽喉痛为9vs4例（P 0.05），两组无返流误吸发生。 结论 SLIPA适合短时间全麻气道管理，可用于困难气管插管的患者，密封效果强于普通喉罩，能有效保证麻醉机的正压通气，可降低气道误吸发生。 【关键词】喉面罩；SLIPA；密封压；呼吸，人工 A comparison of the SLIPA and common LMA in airway managements during general anesthesia Duan Hong-jun, SHI Sheng-nan , ZUO Ming-zhang. Department of Anesthesiology, Beijing Hospital, Beijing 100730, China Abstract Objectives To compare the airway management of SLIPA and common LMA by observing seal pressures, ventilation effects, as well as complications during general anesthesia. Methods 60 ASA physical status I-II patients undergoing elective surgical excisions of breast tumor under general anesthesia were studied, and randomized to receive either type of the SLIPA (Group S) or the common LMA (Group L). The size of devices was determined by bodyweight of patients. Both devices were inserted by hands. Seal pressure was measured and the classification of the laryngeal structure was evaluated by fibro bronchoscope examinations. Anesthesia was induced and maintained with sufentanil0.2g/kg, propofol23mg/kg, vecuronium0.1 mg/kg, supplemented with 12% sevoflurane and 60% nitrous oxide. ECG, artery pressure, SpO2, PET CO2, PPeak were continuously monitored during operations. The time of surgery, emergence and removal of devices were recorded. Whether the inside or bilateral outside of the devices were stained by sputum or blood was observed, as well as regurgitation, aspiration, or sore throats. Result The seal pressure of Group S (23.64.7cmH2O) was significantly higher (P 0.05), comparing to Group L(18.84.5cmH2O). Fibro bronchoscope examinations showed that more status III laryngeal structure were observed in Group L (27/30) (P 0.05), comparing with Group S(19/30). In both groups, normal SpO2, PETCO2, PPeak and stable hemodynamic states were maintained during anesthesia. The occurrence of sputum inside and blood outside the LMA did not differ significantly in the two groups. 9 patients in Group S, and 4 in Group L suffered from sore throats after anesthesia, which showed a significant difference (P0.05). No regurgitation or aspiration occurred in either group. Conclusion The SLIPA shows more hermetic seals than common LMA in assuring intermittent post pressure ventilations provided by anesthesia machines. The utilization of SLIPA is compatible for difficult airway management or short-time cases of general anesthesia, and m