摘要
目的探讨三通喉罩通气在成人支气管镜肺部止血的临床应用。方法实施肺部止血的成人患者9例,年龄21～62岁,在快速诱导麻醉下实施三通喉罩插入。插入成功后,三通喉罩的标准端口连接呼吸机(或麻醉机)进行机械或人工控制通气,从三通喉罩另一带有密封胶帽端口置入纤维支气管镜,经声门进入气管、支气管,实施肺部止血术。记录麻醉前5min时(T0),插入喉罩后即刻(T1),通气1min时(T2),通气3min时(T3),通气10min时(T4),通气20min时(T5),通气30min时(T6),手术结束时(T7)的收缩压(SBP)、舒张压(DBP)、心率(HR)、脉搏氧饱和度(SpO2);记录患者通气T1、T2、T3、T4、T5、T6、T7的潮气量(VT)、气道峰压(Ppeak)及呼气末二氧化碳分压(PETCO2);记录麻醉和手术的效果和过程。结果全部9例手术顺利完成,SpO2在麻醉诱导开始后有明显改善,术中无明显下降;术中全部病例气道压力小幅升高,仍属于正常压力范围,血压、心率无明显变化;术后恢复良好,无明显并发症。结论三通喉罩用于支气管镜肺部止血具有安全、可靠、效果满意、并发症少等优点,在机器控制呼吸下实施手术,取得了呼吸的控制权,保证了良好的通气和氧供,方便了手术操作,提高了麻醉安全性。
Aim To introduce the clinical experience of the use of three-way laryngeal mask airway（TLMA） ventilation in bronchofiberscope hemostasis in lung. Methods 9 patients aged from 23 to 62 yeas and admitted for tracheal intubation with TLMA under general anesthesia in bronchofiberscope hemostasis inl ung. SBP, DBP, HR, and SPO2 , were measured at 5 min after entering the surgery （ T0 ）, immediately after inserting TLMA（ T1 ）, 1 rain after ventilation（ T2 ）, 3 min after ventilation（ T3 ）, 10 min after ventilation（ T4 ）, 20 min after ventilation （ T5 ）, 30 min after ventilation （ T6 ） and immediately end of operatoin （ T7 ）. Peak inspiratory airway presure （Ppeak） ,tidal volume （VT）and PETCO2 were recorded at T2 ,T3 ,T4 ,T5 ,T6 ,T7. Effect of anesthesia and operation were recorded. Results All the operations were successful, satisfactory effects were observed in the 9 cases under study, No side effect and complications were observed in all cases. Conlusion TLMA for bronchofiberscope hemostasis in lung is a simple, safe and economical method, adopting TL- MA to management respiration in general anesthesia undergoing bronchofiberscope hemostasis in lung would control respiration according to demand at any time. It may obtain the respiratory control power, guarantee the good ventilation and oxygen supply and improve the safety of anesthesia considerably.
出处
《临床肺科杂志》
2009年第3期319-320,共2页
Journal of Clinical Pulmonary Medicine
关键词
三通喉罩
通气
支气管镜
肺部止血
three-way Laryngeal mask airway
ventilation
bronchofiberseope
hemostasis in lung
