气管插管而非喉罩置入会导致可逆性支气管收缩。

Endotracheal intubation, but not laryngeal mask airway insertion, produces reversible bronchoconstriction.

作者信息

Kim E S, Bishop M J

机构信息

Anesthesiology, Catholic University Medical College, Seoul, Korea.

出版信息

Anesthesiology. 1999 Feb;90(2):391-4. doi: 10.1097/00000542-199902000-00010.

DOI:10.1097/00000542-199902000-00010

PMID:9952142

Abstract

BACKGROUND

Tracheal intubation frequently results in an increase in respiratory system resistance that can be reversed by inhaled bronchodilators. The authors hypothesized that insertion of a laryngeal mask airway would be less likely to result in reversible bronchoconstriction than would insertion of an endotracheal tube.

METHODS

Fifty-two (45 men, 7 women) patients were randomized to receive a 7.5-mm (women) or 8-mm (men) endotracheal tube or a No. 4 (women) or No. 5 (men) laryngeal mask airway. Anesthesia was induced with 2 microg/kg fentanyl and 5 mg/kg thiopental, and airway placement was facilitated with 1 mg/kg succinylcholine. When a seal to more than 20 cm water was verified, respiratory system resistance was measured immediately after airway placement. Inhalation anesthesia was begun with isoflurane to achieve an end-tidal concentration of 1% for 10 min. Respiratory system resistance was measured again during identical conditions.

RESULTS

Among patients receiving laryngeal mask airways, the initial respiratory system resistance was significantly less than among patients with endotracheal tubes (9.2+/-3.3 cm water x 1(-1) x s(-1) [mean +/- SD] compared with 13.4+/-9.6 cm water x 1(-1) x s(-1); P < 0.05). After 10 min of isoflurane, the resistance decreased to 8.6+/-3.6 cm water x 1(-1) x s(-1) in the endotracheal tube group but remained unchanged at 9.1+/-3.3 cm water x 1(-1) x s(-1) in the laryngeal mask airway group. The decrease in respiratory system resistance in the endotracheal tube group of 4.7+/-7 cm water x 1(-1) x s(-1) was highly significant compared with the lack of change in the laryngeal mask airway group (P < 0.01).

CONCLUSIONS

Resistance decreased rapidly only in patients with endotracheal tubes after they received isoflurane, a potent bronchodilator, suggesting that reversible bronchoconstriction was present in patients with endotracheal tubes but not in those with laryngeal mask airways. A laryngeal mask airway is a better choice of airway to minimize airway reaction.

摘要

背景

气管插管常常导致呼吸系统阻力增加，吸入支气管扩张剂可使其逆转。作者推测，与气管内插管相比，插入喉罩气道引起可逆性支气管收缩的可能性较小。

方法

52例患者（45例男性，7例女性）被随机分为接受7.5mm（女性）或8mm（男性）气管内插管或4号（女性）或5号（男性）喉罩气道。用2μg/kg芬太尼和5mg/kg硫喷妥钠诱导麻醉，并用1mg/kg琥珀酰胆碱辅助气道放置。当证实气道密封压力超过20cm水柱时，在气道放置后立即测量呼吸系统阻力。吸入麻醉开始用异氟烷，使呼气末浓度达到1%，持续10分钟。在相同条件下再次测量呼吸系统阻力。

结果

在接受喉罩气道的患者中，初始呼吸系统阻力显著低于接受气管内插管的患者（9.2±3.3cm水柱×1⁻¹×s⁻¹[平均值±标准差]，而气管内插管患者为13.4±9.6cm水柱×1⁻¹×s⁻¹；P<0.05）。异氟烷吸入10分钟后，气管内插管组阻力降至8.6±3.6cm水柱×1⁻¹×s⁻¹，而喉罩气道组保持不变，为9.1±3.3cm水柱×1⁻¹×s⁻¹。气管内插管组呼吸系统阻力下降4.7±7cm水柱×1⁻¹×s⁻¹，与喉罩气道组无变化相比差异高度显著（P<0.01）。