体位对儿童腹股沟斜疝腹腔镜术后麻醉复苏及气道管理的影响

Effects of different body positions on recovery from anesthesia and airway management during resuscitation after laparoscopic hernia surgery in children

目的探究不同体位对儿童腹股沟斜疝腹腔镜术后麻醉恢复及复苏期气道管理的影响。方法选取2019年1月至2021年12月,海南省妇女儿童医学中心全身麻醉下行腹腔镜疝手术的腹股沟斜疝患儿128例行前瞻性研究,按照随机数字表法分成侧卧位组和平卧位组,各64例,侧卧位组行侧卧位拔管,平卧位组以去枕平卧位拔管,对比2组患儿术后拔管后呛咳发生率、复苏时间、脉搏血氧饱和度(SpO_(2))等。结果2组患儿在性别、身高、年龄、体重、手术时长及术中出血量方面比较无差异(P>0.05);2组患儿在各时间点的SpO_(2)无差异(P>0.05);侧卧位组患儿拔管后躁动时间、苏醒时间及自主呼吸时间明显短于平卧位组(P<0.05);2组患儿拔管后出现躁动、低氧血症、喉痉挛、挣扎方面比较差异无统计学意义(P>0.05);相较于平卧位组,侧卧位组患儿呛咳、呕吐及恶心明显减少(P<0.05)。结论与传统平卧位比较,侧卧位苏醒对全身麻醉下腹腔镜疝手术术后患儿的呼吸道管理更有利,能提高安全性,复苏质量更高。

Objective To investigate the effects of different positions on recovery from anesthesia and airway management during resuscitation after laparoscopic surgery for pediatric inguinal hernia.Methods From January 2019 to December 2021,128 children with inguinal hernias who underwent laparoscopic hernia surgery under general anesthesia at the Women and Children's Medical Center of Hainan Province were selected,and were divided into a lateral recumbent group and a flat recumbent group according to the randomized number table method,64 cases each,and the lateral recumbent group was extubated in the lateral recumbent position and the flat recumbent group was extubated in the decubitus position.The incidence of choking and coughing,resuscitation time,pulse rate and oxygen saturation(SpO_(2))were compared between the two groups.Results There was no difference in gender,height,age,weight,operation time,and intraoperative blood loss between the two groups(P>0.05);there was no difference in SpO_(2)between the two groups at each time point(P>0.05).The time of restlessness,wake-up time and spontaneous breathing after extubation in the supine position group was significantly shorter than that in the supine position group(P<0.05);there was no difference in agitation,hypoxemia,laryngospasm,and struggle after extubation between the two groups(P>0.05);compared with the supine group,the children in the lateral position had significantly lower cough and airway obstruction(P<0.05).Conclusion Compared with the traditional supine position,resuscitation in the lateral position is more beneficial to the airway management of children after laparoscopic hernia surgery under general anesthesia,improves safety,and has a higher resuscitation quality.