周颖 黄静 毛仪娜 王春莹 黄莉 江永强

[摘要]目的觀察自制声门上导管用于困难气道患者无痛胃镜检查的有效性和安全性。方法选取2020年6—12月兵器工业五二一医院收治的80例需无痛胃镜检查的困难气道患者作为研究对象，根据随机数字表法分为观察组（ n=40）和对照组（ n=40）。观察组采用置入声门上导管进行通气，对照组采用内窥镜面罩通气。比较两组麻醉前（T0）、麻醉后2 min（T1）及检查结束时（T2）的平均动脉压（MAP）、心率（HR）、脉搏血氧饱和度（SpO2），并比较两组术中呼吸抑制、托下颌、面罩加压给氧和术后咽喉不适等情况。结果 T1时对照组 SpO2显著低于 T0时，且低于观察组，差异有统计学意义（ P <0.05）;T1、T2时两组 MAP 均低于 T0时，差异有统计学意义（ P <0.05），但组间比较差异无统计学意义（ P >0.05）;观察组呼吸抑制5例，托下颌2例，无面罩加压给氧患者，对照组分别为16、12和4例，组间比较差异均有统计学意义（ P <0.05）;两组术后咽喉不适的比例比较，差异无统计学意义（ P >0.05）。结论自制声门上导管用于困难气道患者行无痛胃镜检查，可有效改善患者肺通气，提高血氧含量，且简单易行，值得推广应用。[关键词]困难气道;无痛胃镜;声门上导管;通气

[中图分类号] R656  [文献标识码] A   [文章编号]2095-0616（2021）23-0174-05

Clinical observation of self-made supraglottic catheter in painless gastroscopy for patients with difficult airwayZHOU  Ying1      HUANG  Jing1      MAO  Yi'na1      WANG  Chunying2      HUANG  Li2JIANG  Yongqiang2

1.Department of Pain， 521 Hospital of Ordnance Industry， Shaanxi， Xi'an 710065， China;2.Department of Gastroenterology， 521 Hospital of Ordnance Industry ， Shaanxi， Xi'an 710065， China

[Abstract] Objective To observe the efficacy and safety of self-made supraglottic catheter in painless gastroscopy for patients with difficult airway. Methods  A total of 80 patients with difficult airway requiring painless gastroscopy admitted to Institute of Industrial Hygiene of Ordnance Industry from June to December 2020 were selected as research objects， and they were randomly divided into the observation group （n=40） and the control group （n=40） based on the random number table method.The observation group received supraglottic catheter for ventilation and the control group was ventilated with endoscopic mask. The mean arterial pressure （MAP）， heart rate （HR）， pulse oxygen saturation （SpO2） before anesthesia （T0）， 2 min after anesthesia （T1） and at the end of examination （T2） were compared between the two groups， and the respiratory depression during operation， jaw thrust， face mask pressurized ventilation and throat discomfort after operation were compared between the two groups. Results The SpO2 in the control group at T1 was significantly lower than that at T0 and lower than that in the observation group， with statistically significant difference （P <0.05）. MAP of both groups at T1 and T2 was lower than that at T0（P <0.05）， but there was no significant difference between the two groups （P >0.05）. In the observation group， there were 5 cases of respiratory depression， 2 cases of jaw thrust and 0 case of face mask pressurized ventilation， and 16 cases， 12 cases and 4 cases in the control group， respectively， with statistically significant differences between the two groups （P <0.05）. There was no statistically significant difference in the proportion of postoperative throat discomfort between the two groups （P >0.05）. Conclusion Self-made supraglottic catheter for painless gastroscopy in patients with difficult airway can effectively improve pulmonary ventilation and blood oxygen content， and it is simple and worthy of popularization and application.

[Key words] Difficult airway; Painless gastroscope; Supraglottic catheter; Ventilation

随着舒适化医疗的普及，行无痛胃镜检查的患者日益增多，但困难氣道患者在麻醉过程中，因镇静药物及镇痛药物的影响可能发生术中低通气，进而造成缺氧，加之患者本身的解剖及病理改变，缺氧耐受性差，气道建立较困难，一旦发生可能危及患者生命安全[1-2]。目前对困难气道患者行无痛胃镜检查多采用内窥镜面罩给氧[3]。该方法虽可提高吸氧的效能，但呼吸抑制时仍不能有效正压通气，且该面罩的胃镜入口影响胃镜操作。……