鼻中隔成形术中喉罩- supreme 与气管插管在气道保护方面的比较：一项随机、单盲、对照临床试验。
A comparison of laryngeal mask airway-supreme and endotracheal tube use with respect to airway protection in patients undergoing septoplasty: a randomized, single-blind, controlled clinical trial.
机构信息
Department of Anesthesiology and Reanimation, Inonu University Medical Faculty, Malatya, Turkey.
Department of Biostatistics and Medical Informatics, Inonu University Medical Faculty, Malatya, Turkey.
出版信息
BMC Anesthesiol. 2021 Jan 7;21(1):5. doi: 10.1186/s12871-020-01222-4.
BACKGROUND
There are doubts among anesthesiologists on the use of the Laryngeal Mask Airway (LMA) in nasal surgeries because of concerns about the occurrence of blood leakages to the airway. We hypothesized that the use of LMA-Supreme (LMA-S) in nasal surgery is comparable with endotracheal tube (ETT) according to airway protection against blood leakage through the fiberoptic bronchoscopy, oropharyngeal leakage pressure (OLP), heart rate (HR), mean arterial pressure (MAP), and postoperative adverse events.
METHODS
The present study was conducted in a prospective, randomized, single-blind, controlled manner on 80 patients, who underwent septoplasty procedures under general anesthesia, after dividing them randomly into two groups according to the device used (LMA-S or ETT). The presence of blood in the airway (glottis/trachea, distal trachea) was analyzed with the fiberoptic bronchoscope and a four-point scale. Both groups were evaluated for OLP; HR; MAP; postoperative sore throat, nausea, and vomiting; dysphagia; and dysphonia.
RESULTS
In the fiberoptic evaluation of the airway postoperatively, less blood leakage was detected in both anatomic areas in the LMA-S group than in the ETT group (glottis/trachea, p = 0.004; distal trachea, p = 0.034). Sore throat was detected less frequently in the LMA-S group at a significant level in the 2nd, 6th, and 12th hours of postoperative period; however, other adverse events were similar in both groups. Hemodynamic parameters were not different between the two groups.
CONCLUSION
The present findings demonstrate that the LMA-S provided more effective airway protection than the ETT in preventing blood leakage in the septoplasty procedures. We believe that the LMA-S can be used safely and as an alternative to the ETT in septoplasty cases.
TRIAL REGISTRATION
This trial is registered at the US National Institutes of Health ( ClinicalTrials.gov ) # NCT03903679 on April 5, 2019.
背景
由于担心气道发生血液渗漏，麻醉医生对在鼻外科手术中使用喉罩气道（LMA）存在疑虑。我们假设，通过纤维支气管镜检查、口咽漏压（OLP）、心率（HR）、平均动脉压（MAP）和术后不良事件，比较 LMA-Supreme（LMA-S）与气管内导管（ETT）在防止气道血液渗漏方面的效果，结果显示 LMA-S 在鼻外科手术中的使用是可以与 ETT 相媲美的。
方法
本研究采用前瞻性、随机、单盲、对照方法，对 80 例接受全身麻醉下鼻中隔成形术的患者进行研究，根据使用的设备（LMA-S 或 ETT）将其随机分为两组。使用纤维支气管镜和四点量表分析气道（声带/气管、远端气管）中的血液情况。对两组患者的 OLP、HR、MAP、术后咽痛、恶心呕吐、吞咽困难和声音嘶哑进行评估。
结果
在术后气道的纤维支气管镜评估中，LMA-S 组在两个解剖区域的气道血液渗漏均少于 ETT 组（声带/气管，p=0.004；远端气管，p=0.034）。LMA-S 组在术后第 2、6 和 12 小时的咽痛发生率显著低于 ETT 组；然而，两组其他不良反应相似。两组间血流动力学参数无差异。
结论
本研究结果表明，在鼻中隔成形术中，LMA-S 比 ETT 更能有效地防止气道血液渗漏。我们认为，在鼻中隔成形术中，LMA-S 可以安全地替代 ETT。
试验注册
该试验于 2019 年 4 月 5 日在美国国立卫生研究院（ClinicalTrials.gov）注册，编号为#NCT03903679。
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