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喉罩用于拔管后上呼吸道梗阻患者气道急救研究
To evaluate the availability of the laryngeal mask in airway rescue for patients with upper airway obstruction after extubation

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DOI:
作者:
李文锋1 刘毅2* 倪文2 熊源长2 邓小明2
Li Wen-feng1, Liu Yi,2 Ni Wen, 2 Xiong Yuan-chang,
作者单位:
1 成都军区昆明总医院麻醉科，650032，昆明 2 第二军医大学长海医院麻醉科，200433 上海
1 Department of Anesthesiology, Kunming general hospital, Chengdu Military Area, Kunming 650032 2 Department of Anesthesiology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China.
关键词:
拔管；上呼吸道梗阻；气道急救；喉罩；危险因素
Extubation; Upper airway obstruction; Airway rescue; LMA; Risk factors
摘要:
目的 评价喉罩用于全麻拔管后上呼吸道梗阻患者的气道急救效果，并筛选喉罩通气失败的危险因素。方法 回顾我院近1年内全麻拔管后发生上呼吸道梗阻、需置入喉罩进行急救的患者，记录患者性别、年龄、体重指数(BMI)、ASA分级、术前肺部疾病史、手术类型、是否留置胃管、气道急救中丙泊酚用量、喉罩置入时间、喉罩置入时是否有吞咽和（或）呛咳反应、操作者使用喉罩经验以及喉罩通气效果。如果喉罩通气失败，需重新置入气管导管。记录人工气道建立成功后的血气结果，人工气道留置时间，患者是否转入ICU以及术后是否出现并发症和（或）死亡。采用logistic回归分析筛选喉罩通气失败的危险因素。结果 78例术后拔管出现上呼吸道梗阻患者使用喉罩急救通气，喉罩通气有效率为78.2%。需再次插管患者动脉氧分压降低明显，人工气道留置时间长，且更多转入ICU。Logistic回归分析显示合并肺部疾病以及上腹部手术是喉罩通气失败的危险因素。结论 喉罩可有效用于全麻拔管后上呼吸道梗阻、面罩通气无效的患者，而合并肺部疾病以及上腹部手术可能导致喉罩通气失败。
Objective To evaluate the availability of laryngeal mask (LMA) in airway rescue when upper airway obstruction occurs after extubation and determine the risk factors for failure in LMA ventilation. Methods Review patients who developed upper airway obstruction after withdraw of endotracheal tube and needed to insert the LMA for ventilation from November 2009 to February 2011. Gender, age, body mass index, ASA classification, preoperative respiratory disease, the type of operation, presence of gastric tube, dose of propofol used in airway rescue, duration of LMA insertion, occurrence of swallow and/or bucking, anesthesiologists’ experience in using LMA, and the effectiveness of LMA ventilation were recorded. LMA was replaced by reintubation if LMA ventilation failed. The blood gas analysis at the time when artificial airway established successfully, the retaining time of artificial airway, the number of patients who transferred to ICU, the morbidity and mortality postoperative were also noted. Logistic regression analysis was used to determine the risk factors for failure in LMA ventilation. Results Seventy-eight patients enrolled in this study. The successful rate of LMA ventilation was 78.2%. For patients undergone reintubation significant decrease in PaO2, longer retaining time of artificial airway, and higher proportion of entering ICU were noted. Preoperative respiratory disease and upper abdominal surgery were identified as risk factors for failure in LMA ventilation. Conclusion LMA is available in airway rescue for patients with upper airway obstruction after extubation. However, preoperative respiratory disease and upper abdominal surgery may lead to failure in LMA ventilation.

 

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