带阻断器的 Air-Q 自加压气道装置与 Proseal 喉罩式气道在接受妇科择期手术的麻醉瘫痪成年女性患者中的应用比较。

IF 1.6 Q2 ANESTHESIOLOGY Anaesthesiology intensive therapy Pub Date : 2024-01-01 DOI:10.5114/ait.2024.141203

Maha Mohammed Ismail Youssef, Naser Mohammed Dobal, Yahya Mohamed Hammad, Nesrine Abdel Rahman El-Refai, Reham Ali Abdelhaleem Abdelrahman

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引用次数: 0

摘要

简介：带阻断器的 Air-Q 自加压气道装置（SP Blocker）与 Proseal 喉罩气道（PLMA）在正压通气期间的主要结果（口咽漏压 [OLP]）进行了比较、次要结果（吸气峰压 [PIP]、吸气潮气量 [ITV]、呼气潮气量 [ETV]、漏气量 [LV] 和漏气分数 [LF]）、插入时间、通气评分、光纤声门视野评分和术后喉咽参数 (LPM)。材料与方法一项前瞻性随机比较临床试验招募了计划在全身麻醉下使用可控机械通气进行妇科开腹手术的成年健康女性患者。排除标准为体重指数（BMI）≥ 35 kg m -2、El-Ganzouri 评分≥ 5、上气道问题、裂孔疝或妊娠。患者被分为 SP 阻滞剂组（75 人）和 PLMA 组（75 人）。在成功插入装置后的初始阶段和固定时间点对主要和次要结果进行评估：在成功插入设备后的初始阶段：SP 阻滞剂组的平均 OLP（cmH 2 O）较高（分别为 29.46 ± 2.11 vs. 28.06 ± 1.83；95% CI：-2.037 至 -0.76，P <0.0001），平均 PIP（cmH 2 O）较低（分别为 15.49 ± 0.61 vs. 17.78 ± 1.04；95% CI：2.02 至 2.56，P <0.0001），平均 ITV（mL）较高（分别为 411 ± 30 vs. 403 ± 15；95% CI：-2.037 至 -0.76，P <0.0001）。分别为 403 ± 15；95% CI：-15.65 至 -0.347，P = 0.041），更高的平均 ETV（毫升）（分别为 389 ± 12 vs. 354 ± 11；95% CI：-38.72 至 -31.29，P < 0.0001），更低的平均 LV（毫升）（分别为 22 ± 18 vs. 49 ± 10；95% CI：-38.72 至 -0.347，P = 0.041）。分别为 49 ± 10；95% CI：22.3 至 31.7，P < 0.0001），平均 LF（%）（分别为 5 ± 2.04 对 12 ± 6.8；95% CI：5.38 至 8.62，P < 0.0001）低于 PLMA 组。SP 阻断器组的平均插入时间（秒）短于 PLMA 组（分别为 16.39 ± 2.81 vs. 18.63 ± 3.44；95% CI：1.23 至 3.25，P <0.0001）。SP阻滞剂组的光纤声门视野评分优于PLMA组，但在通气评分和LPM方面没有差异：结论：SP阻滞剂在控制机械通气期间提供的麻醉与PLMA一样安全。

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Comparison between Air-Q Self Pressurized Airway Device with Blocker and Proseal Laryngeal Mask Airway in anesthetized paralyzed adult female patients undergoing elective gynecological operations.

Introduction: The Air-Q Self Pressurized Airway Device with Blocker (SP Blocker) was compared to the Proseal Laryngeal Mask Airway (PLMA) during positive pressure ventilation regarding the primary outcome (oropharyngeal leak pressure [OLP]), secondary outcomes (peak inspiratory pressure [PIP], inspired tidal volume [ITV], expired tidal volume [ETV], leak volume [LV] and leak fraction [LF]), insertion time, ventilation score, fiber-optic glottis view score, and postoperative laryngopharyngeal parameters (LPM).

Material and methods: Adult healthy female patients scheduled for elective gynecological laparotomies under general anesthesia using controlled mechanical ventilation were recruited to a prospective randomized comparative clinical trial. Exclusion criteria were body mass index (BMI) ≥ 35 kg m -2 , El-Ganzouri score ≥ 5, upper airway problems, hiatus hernia or pregnancy. Patients were classified into an SP Blocker group ( n = 75) and a PLMA group ( n = 75). Primary and secondary outcomes were assessed initially and at fixed time points after successful insertion of devices.

Results: Initially after successful device insertion: the SP Blocker group showed statistically significant higher mean OLP (cmH 2 O) (29.46 ± 2.11 vs. 28.06 ± 1.83 respectively; 95% CI: -2.037 to -0.76, P < 0.0001), lower mean PIP (cmH 2 O) (15.49 ± 0.61 vs. 17.78 ± 1.04 respectively; 95% CI: 2.02 to 2.56, P < 0.0001), higher mean ITV (mL) (411 ± 30 vs. 403 ± 15 respectively; 95% CI: -15.65 to -0.347, P = 0.041), higher mean ETV (mL) (389 ± 12 vs. 354 ± 11 respectively; 95% CI: -38.72 to -31.29, P < 0.0001), lower mean LV (mL) (22 ± 18 vs. 49 ± 10 respectively; 95% CI: 22.3 to 31.7, P < 0.0001) and lower mean LF (%) (5 ± 2.04 vs. 12 ± 6.8 respectively; 95% CI: 5.38 to 8.62, P < 0.0001) than the PLMA group. Mean insertion time (seconds) was shorter in the SP Blocker group than the PLMA group (16.39 ± 2.81 vs. 18.63 ± 3.44 respectively; 95% CI: 1.23 to 3.25, P < 0.0001). The SP Blocker group offered a better fiber-optic glottis view score than the PLMA group without differences concerning ventilation score and LPM.

Conclusions: SP Blocker provided as safe anesthesia during controlled mechanical ventilation as PLMA.

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