喉罩不同充气方式与囊内压和术后咽喉痛发生率的关系

摘要

目的 探讨术中喉罩不同充气方式与囊内压力大小和术后咽喉痛发生率的关系.方法 选取2015年6-12月在大连医科大学附属第二医院经喉罩置入全身麻醉下行乳腺癌根治术患者138例.根据随机数字表法将患者分为渐进充气量组、手感充气量组和最大充气量组,各46例.渐进充气量组患者与麻醉机相连接行机械正压通气,同时使用注射器进行喉罩罩囊充气2 ml,当听诊器置于颈前的甲状软骨外上听诊无漏气后再充气2 ml;手感充气量组操作者左手食指和拇指轻轻捏压喉罩充气指示囊,右手持注射器按0.5 ml/s缓慢充气,至操作者感觉充气套囊硬度与额头相同时为止,再与麻醉机相连接;最大充气量组在喉罩置入后,使用注射器充入最大充气量30 ml,再与麻醉机相连接.3组设置的呼吸参数相同.记录3组患者喉罩置入时间、喉罩置入次数以及术中漏气和喉罩拔出染血的发生率;记录3组患者喉罩囊内压、喉罩充气量和气道峰压情况;观察患者咽部并发症,包括口咽感觉障碍、声音嘶哑、吞咽不适、咽喉痛,并计算并发症持续时间及发生率.结果 3组患者年龄、身高、体质量、体重指数、手术时间、美国麻醉医师协会分级、瑞芬太尼用量和舒芬太尼用量比较,差异均无统计学意义(均P＞0.05).3组患者喉罩置入时间、喉罩置入次数、术中漏气和喉罩拔出染血发生率比较,差异均无统计学意义(均P＞0.05).3组患者气道峰压比较,差异均无统计学意义(均P＞0.05).渐进充气量组喉罩囊内压和喉罩充气量均明显低于手感充气量组和最大充气量组[(27±3)mmHg(1 mmHg=0.133 kPa)比(49±3)、(82±4)mmHg,(10.0±1.2)ml比(17.5±2.4)、(29.4±3.0)ml],差异均有统计学意义(均P＜0.05).3组患者口咽感觉障碍发生率比较,差异均无统计学意义(均P＞0.05).渐进充气量组吞咽不适和咽喉痛发生率均明显低于最大充气量组[4.3％ (2/46)比34.8％ (16/46),4.3％ (2/46)比39.1％ (18/46)],且并发症持续时间均明显短于最大充气量组和手感充气量组[(4.2±0.5)h比(12.1±1.2)、(7.4±0.8)h],差异均有统计学意义(均P＜0.05).结论 渐进充气法可实现有效密封所需的最小充气容量,使通气效果得到保障,同时能达到最小囊内压,降低了术后咽喉痛发生率及缩短了咽喉痛症状持续时间.%Objective To explore the relation among different modes of laryngeal mask aeration,intracapsular pressure and postoperative sore throat.Methods A total of 138 patients undergoing radical mastectomy with general anesthesia by laryngeal mask were enrolled from June 2015 to December 2015 in the Second Hospital of Dalian Medical University.The patients were randomly divided into progressive aeration group,handle aeration group and maximum volume aeration group,with 46 cases in each group.The progressive aeration group had 2 ml aeration by laryngeal mask during mechanical ventilation,followed by 2 ml aeration after no-air leak with stethoscopy at thyroid cartilage.The hander aeration group had 0.5 ml/s aeration by laryngeal mask until the hardness of sac was same as forehead.The maximum volume aeration group had 30 ml aeration by laryngeal mask before mechanical ventilation.laryngeal mask aeration duration,times of aeration,intraoperative air leak,bleeding at laryngeal mask extraction,intracapsular pressure,inflating volume,peak airway pressure and oropharyngeal complications of sensory disorder,hoarseness,dysphagia and sore throat were analyzed.Results Age,height,body mass,body mass index,operation time,grade of American Society of Anesthesiologists,dosages of fentanyl and sufentanil had no significant differences among groups (P ＞ 0.05).Laryngeal mask aeration duration,times of aeration,incidence of intraoperative air leak,incidence of bleeding at laryngeal mask extraction and peak airway pressure had no significant differences among groups (P ＞ 0.05).The intracapsular pressure and inflating volume in progressive aeration group were significantly lower than those in handle aeration group and maximum volume aeration group[(27 ±3)mmHg vs (49±3),(82±4) mmHg;(10.0±1.2)ml vs (17.5 ±2.4),(29.4±3.0)ml](P＜ 0.05).Incidences of dysphagia and sore throat in progressive aeration group were significantly lower than those in maximum volume aeration group[4.3％ (2/46) vs 34.8％ (16/46),4.3％ (2/46) vs 39.1％ (18/46)] (P ＜0.05);duration of complications in progressive aeration group was significantly shorter than that in handle aeration group and maximum volume aeration group [(4.2 ± 0.5) h vs (12.1 ± 1.2),(7.4 ± 0.8) h] (P ＜ 0.05).Conclusion Progressive aeration by laryngeal mask can achieve satisfactory ventilation effect with the minimum intracapsular pressure,reduce the incidence of postoperative sore throat and shorten the duration of symptoms.