摘要
目的比较新型鼻咽通气道和喉罩用于非气管插管胸腔镜手术(NIVATS)患者气道管理的效果。方法本研究为非劣效随机对照试验。选择2021年12月至2023年12月在济宁市第一人民医院行择期NIVATS患者60例,年龄18~79岁,性别不限,ASA分级Ⅰ或Ⅱ级,采用简单随机法,通过计算机生成随机化序列号将患者按1∶1分为2组(n=30):新型鼻咽通气道组(N组)和喉罩组(L组)。麻醉诱导后,N组置入新型鼻咽通气道,L组置入喉罩。2组术中均保留自主呼吸,麻醉诱导前均行超声引导下患侧前锯肌平面阻滞,采用丙泊酚和瑞芬太尼维持麻醉。主要结局指标为术中气道干预率,气道干预措施包括重新调整通气道位置、人工辅助通气、托下颌操作和中转气管内插管。次要结局指标包括通气道首次置入成功率、气道建立时间、SpO_(2)最低值、P_(ET)CO_(2)最高值和术后咽喉疼痛等并发症发生率。结果L组和N组术中气道干预率分别为27%和47%(χ^(2)=2.58,P=0.108),2组术中气道干预率差值为0.20(95%CI 0.15~0.25),其95%CI上限高于非劣效性界值(10%),非劣效性检验未成立。与L组比较,N组术中托下颌操作干预率升高,气道建立时间和术后咽喉疼痛发生率降低(P<0.05)。结论相比喉罩,新型鼻咽通气道可减少术后咽喉疼痛发生,然而保持气道通畅的效果欠佳,用于NIVATS须权衡利弊。
Objective To compare the efficacy of new nasopharyngeal airway and laryngeal mask airway for airway management in the patients undergoing non-intubated video-assisted thoracoscopic surgery(NIVATS).Methods In this randomised,controlled,non-inferiority trial,60 American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ patients of both sexes,aged 18-79 yr,scheduled for elective NIVATS from December 2021 to December 2023 at Jining No.1 People's Hospital,were divided into 2 groups(n=30 each)using a computer-generated random code in a 1∶1 ratio:new type nasopharyngeal airway group(group N)and laryngeal mask airway group(group L).After anesthesia induction,a new nasopharyngeal airway was inserted in group N,and a laryngeal mask airway was inserted in group L.Spontaneous ventilation was maintained during the NIVATS.Ultrasound-guided serratus anterior plane block was performed on the affected side before anesthesia induction.Anesthesia was maintained with propofol and remifentanil.The primary outcome measure was the rate of intraoperative airway intervention,the airway interventions included repositioning of the airway tools,manual assisted ventilation,jaw-thrust maneuver,and conversion to endotracheal intubation.The secondary outcome measures included the first-attempt success rate of airway device placement,time for establishing a patent airway,the minimum value of SpO_(2),the maximum value of P_(ET)CO_(2),and incidence of complications such as postoperative sore throat.Results The rate of intraoperative airway intervention was 27% in group L and 47% in group N(χ^(2)=2.58,P=0.108).The difference in the rate of intraoperative airway intervention between the two groups was 0.20(95%confidence interval 0.15-0.25),with a 95% confidence interval upper limit higher than the non-inferiority boundary(10%),indicating that this non-inferiority hypothesis was not established.In comparison to group L,the rate of intraoperative jaw-thrust maneuver intervention was significantly increased,the time to establish a patent airway was shortened,and the incidence of postoperative sore throat was decreased in group N(P<0.05).Conclusions Compared with the laryngeal mask airway,the new nasopharyngeal airway can reduce the development of postoperative throat pain,however,it is less effective in maintaining a patent airway.It requires careful consideration of risks and benefits when used for NIVATS.
作者
孔宪刚
刘曼曼
魏育涛
李成文
Kong Xiangang;Liu Manman;Wei Yutao;Li Chengwen(Department of Anesthesiology,Jining No.1 People's Hospital,Jining 272011,China;Department of Thoracic Surgery,Jining No.1 People's Hospital,Jining 272011,China;Department of Anesthesiology,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)
出处
《中华麻醉学杂志》
北大核心
2025年第11期1465-1469,共5页
Chinese Journal of Anesthesiology
基金
山东省医药卫生科技发展计划项目(202104110450)。
关键词
喉罩
鼻咽通气道
胸外科手术
电视辅助
麻醉
全身
Laryngeal masks
Nasopharyngeal airway
Thoracic surgery,video-assisted
Anesthesia,general
