超声引导下颏舌骨距离与基于体重法选择ProSeal LMA™型号的比较：一项随机对照研究。

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中文摘要

背景与目的： 传统的基于体重的喉罩（LMA）型号选择与个体上气道解剖结构并不一致，导致装置贴合不理想。超声引导下测量颏舌骨距离（HMD），作为下颌下间隙的指标，已成为一种有前景的基于解剖的替代方法。本研究旨在比较超声引导下基于HMD的型号选择与传统的基于体重的ProSeal LMA™（Teleflex Inc., Wayne, PA, USA）（PLMA）型号选择在择期手术成年患者中的有效性和安全性。
方法： 这项前瞻性、双盲随机对照试验纳入了116名美国麻醉医师协会（ASA）身体状况I-II级、年龄18-60岁、计划在全身麻醉下接受择期手术的成年人。患者被随机分为两组：A组根据体重进行PLMA型号选择，B组进行超声引导下基于HMD的型号选择。主要结局是首次插入成功率。次要结局包括插入时间、尝试次数、需要重新插入以及术后口腔损伤。
结果： 两组的人口学特征具有可比性。两组的首次插入成功率相似（基于体重组为93.1%，HMD组为96.6%；P = 0.67）。平均插入时间相当（18.1 ± 4.8秒 vs. 18.5 ± 4.6秒；P = 0.60）。HMD组主要接受较小的PLMA型号（P < 0.001），但重新插入率或并发症并未增加。术后口腔损伤罕见，两组间相当。
结论： 超声引导下基于HMD的PLMA型号选择提供了一种个体化的、基于解剖的替代体重选择的方法，在实现相当的插入成功率、效率和安全性同时，倾向于解剖上合适的装置型号。

英文摘要

BACKGROUND AND AIMS: Conventional weight-based laryngeal mask airway (LMA) size selection does not consistently correlate with individual upper airway anatomy, leading to suboptimal device fit. Ultrasound-guided measurement of hyomental distance (HMD), an indicator of submandibular space, has emerged as a promising anatomy-based alternative. This study aimed to compare the efficacy and safety of ultrasound-guided HMD-based sizing with conventional weight-based sizing of the ProSeal LMA™ (Teleflex Inc., Wayne, PA, USA) (PLMA) in adult patients undergoing elective surgery.
METHODS: This prospective, double-blinded randomised controlled trial included 116 American Society of Anesthesiologists (ASA) physical status I-II adults aged 18-60 years scheduled for elective surgery under general anaesthesia. Patients were randomised into two groups: Group A underwent PLMA size selection based on body weight, while Group B underwent ultrasound-guided HMD-based size selection. The primary outcome was first-attempt insertion success. Secondary outcomes included insertion time, number of attempts, need for reinsertion, and postoperative oral injury.
RESULTS: Demographic characteristics were comparable between groups. First-attempt insertion success was similar in both groups (93.1% in weight-based group vs. 96.6% in HMD group; P = 0.67). The mean insertion time was comparable (18.1 ± 4.8 s vs. 18.5 ± 4.6 s; P = 0.60). The HMD group predominantly received smaller PLMA sizes (P < 0.001) without increased reinsertion rates or complications. Postoperative oral injury was rare and comparable between groups.
CONCLUSION: Ultrasound-guided HMD-based PLMA sizing provides an individualised, anatomy-based alternative to weight-based selection, achieving comparable insertion success, efficiency, and safety while favouring anatomically appropriate device sizing.