目的：探讨可弯曲喉罩在颌面外科日间手术全身麻醉治疗中应用的可行性、安全性。方法：回顾性研究北京大学口腔医院口腔颌面外科门诊在全身麻醉治疗中应用可弯曲喉罩的日间手术病例40例（3~61岁）,其中男性19例,女性21例,均为美国麻醉...目的：探讨可弯曲喉罩在颌面外科日间手术全身麻醉治疗中应用的可行性、安全性。方法：回顾性研究北京大学口腔医院口腔颌面外科门诊在全身麻醉治疗中应用可弯曲喉罩的日间手术病例40例（3~61岁）,其中男性19例,女性21例,均为美国麻醉医师协会（American Society of Anesthesiologists,ASA）分级Ⅰ~Ⅱ级。术中监测不同时间点,即入室麻醉前（T0,基线值）、插入喉罩后即刻（T1）、手术切开时（T2）、术中15 min（T3）、术毕时（T4）5个时间点的患者生命体征指标,记录喉罩首次置入成功率及改为气管内插管的比例。记录术中体动、低氧血症、呼吸道梗阻情况,记录手术时间、麻醉时间、术毕至拔除喉罩时间、拔除喉罩时体动、呛咳及术后24 h咽痛发生率。术后24 h随访记录有无手术相关并发症（如出血、血肿、及术区神经损伤情况）。结果：40例患者均顺利完成手术,36例患者成功使用可弯曲喉罩（90%,36/40）,男性16例,女性20例,其中喉罩首次置入成功率80%（32/40）,二次尝试成功率50%（4/8）。4例不成功的患者中,3例患者第二次尝试置入喉罩位置仍不理想,改为气管内插管方式;1例患者第二次尝试,喉罩虽顺利置入,但在手术开始前发现胃部胀气,改为气管内插管。36例应用喉罩患者,平均手术时间（46.58±22.57）min,平均麻醉时间（77.97±26.82）min,术毕至拔除喉罩时间（8.31±3.33）min。术中患者均无明显体动,拔除喉罩时轻微体动者11.11%（4/36例）,均无呛咳。术后24 h喉罩组咽痛发生率13.89%（5/36例）。术后无手术治疗相关出血、血肿及术区神经损伤等严重并发症。患者清醒状态下各生命体征基线值T0与麻醉后各时点的数值T1、T2、T3、T4比较,P〈0.01,差异有统计学意义。心率在麻醉后各时点数值T1、T2、T3、T4两两比较,P〉0.05,差异无统计学意义。收缩压与舒张压在麻醉后各时点数值两两比较,T1与T4,T2与T3,差异均无统计学意义（P〉0.05）。呼吸频率手术开始后各时点数值T2、T3与T4间两两比较,P〉0.05,差异无统计学意义。结论：可弯曲喉罩作为一种新型的声门上人工气道方式,应用于颌面外科日间手术的全身麻醉中,具有手术安全性较高、对患者心血管系统影响小、术后并发症少的优点,在临床上应用安全、有效。展开更多
Vascular birthmarks are the most common disease.The morbidity is about 2.5%,most of the lesions occur in oral and maxillofacial regions which accounts for 40%-60% of the total lesions.In 1982,Mulliken and Glowacki pro...Vascular birthmarks are the most common disease.The morbidity is about 2.5%,most of the lesions occur in oral and maxillofacial regions which accounts for 40%-60% of the total lesions.In 1982,Mulliken and Glowacki proposed a biologic classification of vascular birthmarks on the basis of their clinical manifestations,histopathological features,and natural history.They defined hemangiomas as vascular tumors with a growth phase,marked by endothelial proliferation and hypercellularity,and an involutional phase.They recognized that many entities referred to as hemangiomas are actually structural malformations of the vasculature,derived from capillaries,veins,lymph vessels,or arteries or from a combination of these sources.The classification was confirmed and issued by International Society for the study of vascular anomality(ISSVA) in 1988.Waner and Suen amended the above category in 1995.This paper presents the new classification of vascular birthmarks and the developments in this field in re-cent years,including the pathology,clinical features and the therapy.For example,the classification of venular malformation categorized by Waner in 1989;the classification of lymphous malformation by Waner and Suen in 1995;and the treatments according to above classifications.展开更多
文摘目的：探讨可弯曲喉罩在颌面外科日间手术全身麻醉治疗中应用的可行性、安全性。方法：回顾性研究北京大学口腔医院口腔颌面外科门诊在全身麻醉治疗中应用可弯曲喉罩的日间手术病例40例（3~61岁）,其中男性19例,女性21例,均为美国麻醉医师协会（American Society of Anesthesiologists,ASA）分级Ⅰ~Ⅱ级。术中监测不同时间点,即入室麻醉前（T0,基线值）、插入喉罩后即刻（T1）、手术切开时（T2）、术中15 min（T3）、术毕时（T4）5个时间点的患者生命体征指标,记录喉罩首次置入成功率及改为气管内插管的比例。记录术中体动、低氧血症、呼吸道梗阻情况,记录手术时间、麻醉时间、术毕至拔除喉罩时间、拔除喉罩时体动、呛咳及术后24 h咽痛发生率。术后24 h随访记录有无手术相关并发症（如出血、血肿、及术区神经损伤情况）。结果：40例患者均顺利完成手术,36例患者成功使用可弯曲喉罩（90%,36/40）,男性16例,女性20例,其中喉罩首次置入成功率80%（32/40）,二次尝试成功率50%（4/8）。4例不成功的患者中,3例患者第二次尝试置入喉罩位置仍不理想,改为气管内插管方式;1例患者第二次尝试,喉罩虽顺利置入,但在手术开始前发现胃部胀气,改为气管内插管。36例应用喉罩患者,平均手术时间（46.58±22.57）min,平均麻醉时间（77.97±26.82）min,术毕至拔除喉罩时间（8.31±3.33）min。术中患者均无明显体动,拔除喉罩时轻微体动者11.11%（4/36例）,均无呛咳。术后24 h喉罩组咽痛发生率13.89%（5/36例）。术后无手术治疗相关出血、血肿及术区神经损伤等严重并发症。患者清醒状态下各生命体征基线值T0与麻醉后各时点的数值T1、T2、T3、T4比较,P〈0.01,差异有统计学意义。心率在麻醉后各时点数值T1、T2、T3、T4两两比较,P〉0.05,差异无统计学意义。收缩压与舒张压在麻醉后各时点数值两两比较,T1与T4,T2与T3,差异均无统计学意义（P〉0.05）。呼吸频率手术开始后各时点数值T2、T3与T4间两两比较,P〉0.05,差异无统计学意义。结论：可弯曲喉罩作为一种新型的声门上人工气道方式,应用于颌面外科日间手术的全身麻醉中,具有手术安全性较高、对患者心血管系统影响小、术后并发症少的优点,在临床上应用安全、有效。
文摘Vascular birthmarks are the most common disease.The morbidity is about 2.5%,most of the lesions occur in oral and maxillofacial regions which accounts for 40%-60% of the total lesions.In 1982,Mulliken and Glowacki proposed a biologic classification of vascular birthmarks on the basis of their clinical manifestations,histopathological features,and natural history.They defined hemangiomas as vascular tumors with a growth phase,marked by endothelial proliferation and hypercellularity,and an involutional phase.They recognized that many entities referred to as hemangiomas are actually structural malformations of the vasculature,derived from capillaries,veins,lymph vessels,or arteries or from a combination of these sources.The classification was confirmed and issued by International Society for the study of vascular anomality(ISSVA) in 1988.Waner and Suen amended the above category in 1995.This paper presents the new classification of vascular birthmarks and the developments in this field in re-cent years,including the pathology,clinical features and the therapy.For example,the classification of venular malformation categorized by Waner in 1989;the classification of lymphous malformation by Waner and Suen in 1995;and the treatments according to above classifications.
