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| AuraFlex喉罩在老年患者脊柱外科手术中的应用 |
| Safety of AuraFlex laryngeal mask airway used for spinal sugery in aged patients |
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| DOI：10.12089/jca.2018.07.010 |
| 中文关键词: 气道管理 喉面罩 脊柱 老年 |
| 英文关键词: Airway management Laryngeal masks Spine Aged |
| 基金项目: |
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| 中文摘要: |
目的 观察AuraFlex喉罩在老年患者脊柱外科手术中应用的安全性和有效性。
方法 选择择期全麻下脊柱外科俯卧位手术的老年患者127例, 男74例, 女53例, 年龄65～79岁, 体重45～90 kg, BMI 18.5～25.0 kg/m2, ASA Ⅱ或Ⅲ级, 随机分为两组：喉罩组(L组)和气管导管组(T组), 全麻诱导后分别置入AuraFlex喉罩(L组)或钢丝加强型气管导管(T组)。记录诱导开始前(T0)、人工气道置入前(T1)、置入后1 min(T2)、置入后3 min(T3)、拔除前(T4)、拔除后1 min(T5)、拔除后3 min(T6)的HR、SBP、DBP。记录置入时间、置入次数。记录平卧位改俯卧位前后气道峰压（Ppeak）、喉罩气道密封压（PAS）和纤维支气管镜检查分级（FBS）。记录手术开始时、手术开始后1 h、手术开始后2 h和手术结束时Ppeak和PAS。记录拔管前FBS。记录拔除人工气道时至拔除后30 min内, 有无低氧血症(SpO2<90%)、喉痉挛、呛咳、呕吐、咽喉痛, 人工气道的套囊或管壁内外有无血迹和污物。
结果 与T0时比较, T2、T3、T5时T组HR明显增快、SBP和DBP明显升高(P<0.05或P<0.01), 且明显高于L组(P<0.05或P<0.01)。两组组内组间不同时点Ppeak和纤维支气管镜分级差异均无统计学意义。人工气道拔出时和拔出后30 min内, L组的呛咳、咽喉痛发生率和低氧血症、声音嘶哑发生率明显低于T组(P<0.05或P<0.01)。
结论 在选择好适应证和加强监测的前提下,相较于钢丝加强气管导管，应用AuraFlex喉罩围术期循环更稳定, 术后呼吸道并发症更少，可以安全有效地用于老年患者脊柱外科手术。 |
| 英文摘要: |
Objective To estimate the security and feasibility of AuraFlex laryngeal mask airway for spinal surgery in aged patients.
Methods One hundred and twenty-seven elderly patients scheduled for lumbar spine operation or cervical vertebra surgery under intravenous general anesthesia, 74 males and 53 females, aged 65-79 years, weighting 45-90 kg, BMI 18.5-25.0 kg/m2, ASA physical status Ⅱ or Ⅲ, were randomly divided into two groups (n=65): AuraFlex LMA group (group L) and reinforced tracheal tube group (group T). HR, SBP and DBP were recorded before anesthesia induction (T0) and before intubation (T1), 1 min after intubation (T2), 3 min after intubation (T3), before extubation (T4), 1 min after extubation (T5), 3 min after extubation (T6) as well. Duration and times of insertion were recorded.Peak airway pressure (Ppeak) , airway sealing pressure (PAS) and Fiberoptic Bronchoscopy Scale (FBS) were recorded in supine and prone position ,at the start of surgery,1 h and 2 h later, the end of surgery,and before extubation. Finally, respiratory complications after extubation were observed.
Results HR, SBP and DBP in group T were significantly higher than in group L at T2, T3 and T5 (P<0.01 or P<0.05), as well as significantly higher at T2 than T0 and T5 than T4 (P<0.01 or P<0.05). Ppeak in group L as the same as in group T as well as FLS. With less hypoxia and hoarseness in group L, the incidences of coughing and pharyngalgia after extubation were significantly lower in group L than in group T (P<0.01 or P<0.05).
Conclusion Under suitable conditions, auraflex laryngeal mask airway can be safely used in aged patients undergoing spinal surgery, which even is superior to reinforced tracheal tube in some aspects. |
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