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| SaCo可视喉罩和Supreme喉罩在牙齿缺失老年患者全麻手术中的比较 |
| Comparison of SaCo visual laryngeal mask and Supreme laryngeal mask during general anesthesia in elderly patients with missing teeth |
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| DOI：10.12089/jca.2025.01.006 |
| 中文关键词: SaCo可视喉罩 Supreme喉罩 老年 牙齿缺失 气道管理 |
| 英文关键词: SaCo visual laryngeal mask Supreme laryngeal mask Aged Missing teeth Airway management |
| 基金项目:亳州市卫生健康委员会课题（bzwj2022b011） |
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| 中文摘要: |
目的：评估SaCo可视喉罩和Supreme喉罩在老年患者牙齿缺失全麻手术中的应用效果。
方法：选择择期全麻下行股骨粗隆间骨折复位内固定术或膝关节置换术的牙齿缺失老年患者80例，男33例，女47例，年龄65～85岁，BMI 18.5～30.0 kg/m2，ASA Ⅰ—Ⅲ级。采用随机数字表法将患者分为两组：Supreme喉罩组（S组）和SaCo可视喉罩组（V组），每组40例。麻醉诱导后置入喉罩，放置胃管后行机械通气。记录喉罩置入前即刻、喉罩置入后即刻、喉罩置入后1 min、拔除喉罩前即刻、拔除喉罩后即刻、拔除喉罩后1 min的HR、MAP、SpO2。记录内窥镜显露分级（EVGS）、对位准确例数、气道密封压、气道峰压（Ppeak）、呼气末二氧化碳分压（PETCO2）、漏气发生例数以及喉罩放置不良反应发生情况。记录喉罩首次置入成功例数、喉罩置入和拔除时间、拔管后30 min的Aldrete苏醒评分和术后1 d恢复质量评分（QoR-15）。
结果： 与喉罩置入前即刻比较，喉罩置入后1 min两组HR明显增快（P<0.05），且S组HR明显快于V组（P<0.05）。与S组比较，V组对位准确率、气道密封压、喉罩首次置入成功率明显升高（P<0.05），漏气发生率明显降低（P<0.05），喉罩置入时间明显延长（P<0.05）。两组EVGS、PETCO2、喉罩拔除时间差异无统计学意义。与S组比较，V组患者术后24 h内咽痛的发生率明显降低（P<0.05），拔管后30 min的改良Aldrete苏醒评分、术后1 d QoR-15明显升高（P<0.05）。
结论：在牙齿缺失老年患者的气道管理中，SaCo可视喉罩较Supreme喉罩具有更高的对位准确率和更低的漏气发生率等优势，可提供更安全、有效的气道管理。 |
| 英文摘要: |
Objective: To evaluate the effect of the SaCo visual laryngeal mask and the Supreme laryngeal mask in elderly patients with missing teeth under general anesthesia.
Methods: Eighty elderly patients with missing teeth, 33 males and 47 female, aged 65-85 years, BMI 18.5-30.0 kg/m2, and ASA physical status Ⅰ-Ⅲ, who underwent scheduled femoral intertrochanteric fracture reduction and internal fixation or knee joint replacement under general anesthesia. The patients were randomly assigned to two groups: the Supreme laryngeal mask group (group S) and the SaCo visual laryngeal mask group (group V), 40 patients in each group. Following anesthesia induction, a laryngeal mask was inserted, and gastric tube placement was followed by mechanical ventilation. The HR, MAP, and SpO2 were recorded immediately prior to laryngeal mask insertion, immediately after insertion, 1 minute after insertion, immediately before removal, immediately after removal, and 1 minute post-removal. Endotracheal visualization grading score (EVGS), the number of correct insertions, airway sealing pressure, peak airway pressure (Ppeak), end-tidal carbon dioxide pressure (PETCO2), the incidence of air leaks, and adverse events related to the laryngeal mask were rearded. The number of successful first-time insertions, laryngeal mask insertion and removal time, Aldrete recovery scores 30 minutes post-extubation, and quality of recovery-15 (QoR-15) on postoperative day 1 were also documented.
Results: Compared with immediately before laryngeal mask insertion, the HR was significantly increased 1 minutes after laryngeal mask insertion in two groups (P < 0.05), and HR in group S was significantly higher than that in group V (P < 0.05). Compared with group S, alignment accuracy, the airway seal pressure, first insertion success rate, and mask insertion time in group V were significantly increased (P < 0.05), and the incidence of air leak was significantly decreased (P < 0.05). There was no statistically significant difference between the two groups in EVGS, PETCO2, and laryngeal mask removal time. Compared with group S, the incidence of postoperative sore throat within 24 hours was significantly decreased in group V (P < 0.05), the modified Aldrete awakening score 30 minutes after extubation and the QoR-15 1 day after surgery were significantly higher in group V (P < 0.05).
Conclusion: For airway management of elderly patients with missing teeth, the SaCo visual laryngeal mask has the advantages of a lower air leak rate and higher airway seal pressure than the Supreme laryngeal mask, and can provide safer and more effective airway management. |
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