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Double tube laryngeal mask the comparison of three methods of insertion
double tube laryngeal mask ( ProsealLMA) There are three kinds of placement method. 1: auxiliary finger placement, 2: guide the secondary placement, 3: bougie auxiliary placement. This test is mainly to compare the three methods of placement for muscle loose, general anesthesia in placing time, the success rate, oropharynx, sealing, counterpoint, pharyngeal damage and hemodynamics and other differences. Discuss the most appropriate clinical double tube laryngeal mask placement method.
method: choose 90 ASAI - Ⅱ level, age 18 60 patients, randomly divided into D ( Digital, finger auxiliary placement) ，IT( Introducer, guides the auxiliary placement) ，GEB( Gumelasticbougie bougie auxiliary placement) Three groups. D group and IT's placement steps to consult the LMAAirwaysManual. The patient supine position under anesthesia, head gasket 7 cm high, the smell flowers. Induced by Rayleigh fentanyl and propofol target control input, the target concentration were 3 ng/L and 4 mu g/L, card muscle ning 0. 6 mg/kg of single intravenous injection. Observe and record three placement method to establish effective airway time, success rate of placement, oropharynx, sealing, para ( Bronchoscopy observe the glottis exposure in the mirror, divided into 1/2/3/4) Pharyngeal injury, patients, and blood pressure, heart rate changes. Surgery asked if patient pharyngeal pain after 24 hours.
result: establish effective airway time IT group was obviously longer than D group and GEB group ( p < 0。 05) The GEB no significant statistical difference between group and group D ( The IT group: 39 + 8 s; Group D: 35 + 7 s; GEB group: 34 + 4 s) 。 In the success rate for the first time to GEB group was obviously higher than that of group D and IT groups ( GEB：28/30，93％； Group D: 22/30,73 %; The IT group: 22/30,73 %) ( P < 0。 05) 。 GEB oropharyngeal sealing pressure is higher than D group and IT groups ( p < 0。 05) Group, group D and IT no statistical difference ( GEB groups: 35 + 4 cmh2o; Group D: 33 + 4 cmh2o. The IT group: 32 + 4 cmh2o) 。 Fiberoptic bronchoscopy vision ratings of GEB group was obviously better than that of group D, the IT group ( According to 1/2/3/4 order, GEB groups: 14/10/4/2; Group D: 5/6/13/6; IT groups: 8/6/10/6) ( p < 0。 05) 。 After the surgery, three groups of laryngeal mask has not been found visible blood on his body, of three groups of patients after operation 24 hours sore throat rate has no obvious difference. Of three groups of patients, the systolic pressure, diastolic pressure and heart rate in all there is no statistical difference of the selected point in time. Of three groups of patients, the systolic pressure, diastolic pressure after induced a marked decline of ( p < 0。 05) , increased heart rate, P < 0。 05) , placing a laryngeal mask instantly, in 1, 2, 3 minutes after laryngeal mask, of three groups of patients with systolic blood pressure, diastolic blood pressure, heart rate change is not big, no statistical difference compared with consciousness disappears ( p> 0。 05) , but significantly lower than the home blood pressure.
conclusion: auxiliary method with finger compared to boot device auxiliary method, guided bougie double tube laryngeal mask placement method for the first time, the success rate is high, counterpoint is more ideal, oropharynx, sealing pressure is high, and in short time. Three methods in hemodynamic changes before and after laryngeal mask has no obvious difference, pharyngeal similar injury and sore throat. So we think the bougie auxiliary double tube laryngeal mask in the method have more advantages, should be the preferred placement method of double tube laryngeal mask.
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