摘要
目的通过对喉罩、气管内插管及静脉氯胺酮三种全麻方式在小儿角膜移植手术中的比较,探讨喉罩的优越性。设计回顾性病例系列。研究对象60例择期行穿透性角膜移植术的患儿。方法所有患儿用抽签法进行随机分组,喉罩组(L组)、气管插管组(T组)、静脉氯胺酮组(K组)各20例,分别给予喉罩全麻、气管内插管全麻和氯胺酮静脉全麻。术中、术后观察T组和L组麻醉诱导时间,插管(或喉罩)前、后心率(HR)和平均动脉压(MAP)的变化,术中异氟醚的吸入浓度,因眼压升高影响手术操作及术中患儿体动的发生率,清醒时间,术后并发症(包括恶心、呕吐和咽痛)的发生率。主要指标麻醉诱导时间,插管前后HR,MAP,眼压升高影响手术操作发生率,清醒时间,术后并发症发生率。结果各组平均诱导插管时间分别为:L组(44.2±8.1)秒,T组(51.4±10.3)秒,两组比较差异无统计学意义(P=0.061)。插管后T组HR和MAP分别为(135±15)次/分及(102.56±3.29)mmHg,与插管前相比明显升高(P=0.023.P=0.012),L组插入喉罩后HR和MAP分别为(113±13)次/分及(86.56±3.29)mmHg,与插入喉罩前相比无明显变化(P=0.361,P=0.574)。术中L组异氟醚平均吸入浓度为(1.1±0.2)%,T组为(1.7±0.5)%,两组比较差异有统计学意义(P=0.014);K组术中8例出现肢体不自主活动,L组及T组无一例出现肢动;因眼压升高出现虹膜膨出影响手术操作者K组9例,T组3例,L组无;清醒时间L组(8.8±3.7)分钟,T组(12.5±5.3)分钟,K组(443±13.9)分钟,K组最长,L组最短;术后恶心呕吐K组5例,T组1例,L组1例;术后咽痛T组6例,L组1例,K组无。结论使用喉罩通气进行吸入全麻,诱导清醒迅速,术中生理指标变化小,术后并发症少,用于小儿角膜移植手术安全性好,操作简便,较其余两种方式更有优越性。(眼科,2008,17:134-136)
Objective To assess the advantage of laryngeal mask (LM) in pediatric penetrating keratoplasty (PK) under general anesthesia. Design Retrospective case series. Participants 60 children underwent PK. Methods All children were randomly divided into 3 groups by lot, with 20 each. Children were given laryngeal mask anesthesia (group L), tracheal intubation anesthesia (group T) and intravenous ketamine anesthesia (group K) respectively. The induction time, change of HR (heart rate) and MAP (medium arteris presure) before and after intubation; consumption of Isoflurane were compared between group T and group L; Body movement, operation interruption because of high IOP, awake time and postoperative complications (nausea, vomiting and sorethroat) were measured in all three groups. Main Outcome Measures Induction time, HR, MAP, operation interruption because of high IOP, awake time and postoperative complications in all groups. Results There was no significant difference on induction time between group L (44.2±8.1 sec.) and group T (51.4±10.3 sec.). HR and MAP, which were 135±15 bpm and 102.56±3.29 mmHg respectively, were significant higher after intubation in group T than that in group L (with HR 113±13 bpm, MAP, 86.56±3.29 mmHg). Inspired Isoflurane concentration in group L (1.1±0.2%) was less than that in group T (1.7±0.5%). Body movement were observed in 8 patients in group K while no patient was found in group L and T. Operation was influenced by increased IOP in 9 patients in group K, 3 patients in group T, none in group L. Awake time in group L (8.8±3.7 min) was shorter than that in group K (44.3±13.9 rain) and group T (12.5±5.3 min). Sore throat was observed in 6 patients in group T, 1 patient in group L; Postoperative vomiting was observed in 5 patients in group K and 1 patient in each other groups. Conclusions Anesthesia with LM provides a safe and effective method for pediatric PK and has more advantages compared with the other two methods.
出处
《眼科》
CAS
2008年第2期134-136,共3页
Ophthalmology in China
关键词
喉罩
小儿全身麻醉
穿透性角膜移植术
laryngeal mask
pediatric general anesthesia
penetrating keratoplasty