Cook T M, McKinstry C, Hardy R, Twigg S
Royal United Hospital, Combe Park, Bath, UK.
Br J Anaesth. 2003 Nov;91(5):678-83. doi: 10.1093/bja/aeg239.
The Laryngeal Tube (LT) performs similarly to the classic laryngeal mask airway during controlled ventilation but with an improved airway seal. We compared the laryngeal tube with the ProSeal laryngeal mask airway (PLMA) throughout anaesthesia.
Thirty-two patients were studied using a randomized cross-over design. The primary outcome measure was airway seal pressure. Secondary outcome measures included peak and plateau airway pressures, time to achieve an airway, ease of insertion, airway manipulations required to achieve a patent airway and grade of fibre-optic laryngoscopy. The proportion of patients in whom good, fair or failed ventilation was achieved was also calculated.
No significant difference was found in regard to seal pressure (PLMA, median 26.5 cm H2O, range 10-40; LT, median 24, range 6-40; P=0.7, 95% confidence interval of the difference 3.5 to -4.0). There were two failures of insertion or ventilation in the LT group and none in the PLMA group. The peak airway pressure with the PLMA was lower than with the LT but the difference was clinically unimportant (PLMA, mean 16.2 cm H2O, SD 3.52; LT, mean 17.9, SD 5.21; P=0.02, 95% confidence interval of the difference -3.1 to -0.28). The PLMA took significantly less time to insert than the LT (PLMA, median 18.5 s, interquartile range 14-26; LT, median 22, interquartile range 15-36.5; P<0.02, 95% confidence interval of the difference -21.5 to -1.0). The PLMA gave a significantly better view on fibre-optic laryngoscopy than the LT (P<0.001, 95% confidence interval of the difference in grade -2.0 to -1.0). In the 16 patients in whom the PLMA was used during maintenance of anaesthesia ventilation was good in 15, fair in none and failed in one. The equivalent figures for the LT were good in nine, fair in six and failed in one (P=0.009). There was no significant difference in the plateau airway pressure, ease of insertion of the devices, number of manipulations required to achieve or maintain an airway, or in overall complications.
The two devices performed equally well in terms of seal pressure. The PLMA was quicker to insert. Efficacy of ventilation was significantly better with the PLMA than the LT. The PLMA allowed a significantly better view of the larynx with a fibre-optic laryngoscope, and may therefore be of more use in cases where visualization of the larynx is required.
喉管（LT）在控制通气期间的表现与经典喉罩气道相似，但气道密封性有所改善。我们在整个麻醉过程中对喉管与食管引流型喉罩气道（PLMA）进行了比较。
采用随机交叉设计对32例患者进行研究。主要观察指标为气道密封压。次要观察指标包括气道峰压和平台压、建立气道的时间、插入的难易程度、建立通畅气道所需的气道操作以及纤维喉镜检查分级。还计算了实现良好、尚可或失败通气的患者比例。
在密封压方面未发现显著差异（PLMA，中位数26.5 cmH₂O，范围10 - 40；LT，中位数24，范围6 - 40；P = 0.7，差异的95%置信区间为3.5至 - 4.0）。LT组有2例插入或通气失败，PLMA组无失败病例。PLMA的气道峰压低于LT，但差异在临床上无重要意义（PLMA，均值16.2 cmH₂O，标准差3.52；LT，均值17.9，标准差5.21；P = 0.02，差异的95%置信区间为 - 3.1至 - 0.28）。PLMA的插入时间明显短于LT（PLMA，中位数18.5秒，四分位间距14 - 26；LT，中位数22，四分位间距15 - 36.5；P < 0.02，差异的95%置信区间为 - 21.5至 - 1.0）。PLMA在纤维喉镜检查中的视野明显优于LT（P < 0.001，分级差异的95%置信区间为 - 2.0至 - 1.0）。在麻醉维持期间使用PLMA 的16例患者中，15例通气良好，无尚可通气者，1例通气失败。LT的相应数据为9例良好，6例尚可，1例失败（P = 0.009）。在平台气道压、装置插入难易程度、建立或维持气道所需的操作次数或总体并发症方面无显著差异。
两种装置在密封压方面表现相当。PLMA插入更快。PLMA的通气效果明显优于LT。PLMA使用纤维喉镜时对喉部的视野明显更好，因此在需要观察喉部的情况下可能更有用。
