三通喉罩在无痛纤维支气管镜检查中的应用

目的：探讨三通喉罩在无痛纤维支气管镜检查中的安全性和可行性。方法：选择年龄65岁以下，ASAⅠ～Ⅱ级患者，按照自愿的原则分为静脉全麻组（IA）和局麻组（LA）。局麻组术前30min肌注鲁米那100mg＋阿托品0．5mg，检查前经环甲膜穿刺注射2％利多卡因3mL做表麻。静脉全麻组静脉快速诱导后插入TLMA，插入成功后，TLMA标准端口连接麻醉机，纤支镜从直管带密封口置入进行检查、活检。记录麻醉前（T0）、纤支镜过声门即刻（T1）、纤支镜探查／活检时（T2）、术毕5min（T3）各时间点的SBP、DBP、HR和SPO2；记录检查中发生低氧事件的情况、检查时间、苏醒时间。结果：19例无痛纤支镜顺利完成，患者术中循环平稳，SPO：变化于正常范围内，无呛咳、体动、低氧等不良事件，与局麻组比较差异有统计学意义（P〈0．05），静脉全麻组患者和内镜医师满意度高。结论：TLMA应用于无痛纤支镜检查安全可靠、效果满意，能同时满足麻醉医师和内镜医师对气道的管理需要，具有临床应用价值。

Application of Three-way Laryngeal Mask Airway to Painless Fiberoptic Bronchoscopy under Intravenous Anesthesia

Objective： To investigate the safety and feasibility of three-way laryngeal mask airway used in painless fibreoptic bronchoscopy. Methods： Patients aged under 65 years old and ASA I- II were divided into intravenous anesthesia group （IA,n= 19） and local anesthesia group （LA,n=20） according to the principle of voluntary. Patients in group LA were intramuscular injection with luminal 100 mg and atropine 0.5 mg 30 minites before operation. Then 3 mL lidocaine was injected via cricothyroid membrane pre-operation. Patients in group IA were inserted with three-way laryngeal mask airway after rapid induction of anesthesia. SBP, DBP, HR, and SPO2 were recorded at the moments in pre-anesthesia（T0）, fibreoptic bronchoscopy through the glottis（T1）, perform a biopsy （T2）, 5 minutes after-operation（T3）. The hypoxic events, check time and wake time were recorded during operation. Results： All patients finished painless fihreoptic bronchoscopy successfully, had stable hamodynamics, no side effect and complications in any cases （P〈0.05）. In group IA, satisfaction from patients and endoscopic physicians was high. Conclusion： Three-way laryngeal mask airway under intravenous anesthesia in painless fibreoptic bronchoscopy is a simple and safe method. The use of TLMA can satisfy the anesthesiologist and endoscopic physicians to airway management needs at the same time. It may obtain the respiratory control power, guarantee good ventilation and oxygen supply, and considerably improve the safety of anesthesia.