双管喉罩在小儿三脑室底部造瘘术中的应用

Application of proseal laryngeal mask airway in pediatric undergoing ETV

目的探讨双管喉罩应用于儿童中、小手术的可行性和安全性。方法将择期在脑室镜下行三脑室底部造瘘术（ETV）的32例全麻患儿随机分为气管导管组（TT组,n=16）和双管喉罩组（PLMA组,n=16）。观察并记录患儿麻醉诱导前（T0）,插入双管喉罩后即刻（T1）,切皮时（T2）,间歇通气30（T3）、60min（T4）,拔除双管喉罩后即刻（T5）平均动脉压（MAP）和心率（HR）及T1、T2、T3、T4时潮气量（VT）、气道峰压（Peak）、气道平台压（Plat）、呼气末二氧化碳分压（PETCO2）等。同时记录拔管或拔喉罩后恶心、呕吐及咽部疼痛等不良反应发生率。结果两组患儿T1、T2、T5与T0比较,MAP和HR均升高;TT组患儿T1、T5MAP和HR升高幅度大于PLMA组（P〈0.05）;两组患儿T1、T2、T3、T4时VT、Peak、Plat、PETCO2及拔管或拔喉罩后恶心、呕吐发生率无明显差异（P〉0.05）;TT组患儿拔管后咽喉部疼痛发生率明显高于PLMA组（P〈0.01）。结论 PLMA技术操作简便,能保证循环、通气功能稳定,减少术后不良反应发生率,适用于不需特殊体位的儿童中、小手术的麻醉。

Objective To observe the changes of ventilation function and explore the feasibility and security with proseal laryngeal mask airway in pediatric undergoing endoscopic third ventriculostomy.Methods 32 pediatric patients with uncommunicating hydrocephalus undergoing endoscopic third ventriculostomy were randomly divided into endotracheal intubation group（TT group,n=16）and proseal laryngeal mask group（PLMA group,n=16）.MAP and HR were measured before induction of anesthesia（T0）,immediately after PLMA insertion（T1）,during skin incision（T2）,30 min of intermittent positive pressure ventilation（T3）,60 min（T4）,immediately after PLMA withdrawl（T5）.VT,Peak,Plat,PETCO2were recorded at immediately after PLMA insertion（T1）,skin incision（T2）,30 min of intermittent positive pressure ventilation（T3）,60 min（T4）and observe the incidence of adverse responses after PLMA withdrawl.Results MAP and HR in two group pediatrics patients with T1,T2,T5 compared with T0rose obviously.Compared with PLMA group,The TT group of pediatric patients with MAP and HR was obviously higher at T1,T5（P〈0.05）.There was no significant difference in VT,Peak,Plat,PETCO2at T1,T2,T3,T4 and incidence of nausea and vomiting after PLMA withdrawl between the two groups（P〉0.05）.The incidence of pharynx pain in group TT was higher than group PLMA（P〈0.01）.Conclusion PLMA ventilation is efficacious for mechanical ventilation with simpler operation and can ensure haemodynamic stability,reduce the incidence of adverse responses,is a viable and an ideal method in pediatric anesthesia.