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1、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,ASAⅠ或Ⅱ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2~3mg/kg、舒芬太尼0.2μg/kg和维库溴铵0.1mg/kg,维持用药为1~2%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
2、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(23.6±4.7)cmH2O高于L组(18.8±4.5)cmH2O(P<0.05),纤支镜检查Ⅲ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
3、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AcomparisonoftheSLIPAandcommonLMAinairwaymanagementsduringgeneralanesthesiaDuanHong-jun,SHISheng-nan,ZUOMing-zhang.DepartmentofAnesthesiology,BeijingHospital,Beijing100730,China[Abstract]ObjectivesTocomparethea
4、irwaymanagementofSLIPAandcommonLMAbyobservingsealpressures,ventilationeffects,aswellascomplicationsduringgeneralanesthesia.Methods60ASAphysicalstatusI-IIpatientsundergoingelectivesurgicalexcisionsofbreasttumorundergeneralanesthesiawerestudied,andrandomizedtoreceiveeithertypeoft
5、heSLIPA(GroupS)orthecommonLMA(GroupL).Thesizeofdeviceswasdeterminedbybodyweightofpatients.Bothdeviceswereinsertedbyhands.Sealpressurewasmeasuredandtheclassificationofthelaryngealstructurewasevaluatedbyfibrobronchoscopeexaminations.Anesthesiawasinducedandmaintainedwithsufentanil
6、0.2μg/kg,propofol2~3mg/kg,vecuronium0.1mg/kg,supplementedwith1~2%sevofluraneand60%nitrousoxide.ECG,arterypressure,SpO2,PETCO2,PPeakwerecontinuouslymonitoredduringoperations.Thetimeofsurgery,emergenceandremovalofdeviceswererecorded.Whethertheinsideorbilateraloutsideofthedevicesw
7、erestainedbysputumorbloodwasobserved,aswellasregurgitation,aspiration,orsorethroats.ResultThesealpressureofGroupS(23.6±4.7cmH2O)wassignificantlyhigher(P<0.05),comparingtoGroupL(18.8±4.5cmH2O).FibrobronchoscopeexaminationsshowedthatmorestatusIIIlaryngealstructurewereobservedinGr
8、oupL(27/30)(P<0.05),comparingwithGroupS(19/30).Inbothg