ProSeal喉罩用于体外循环心内直视术患儿气道管理的效果

Use of laryngeal mask airway ProSeal for airway management during open heart surgery performed under CPB in children

目的 评价ProSeal喉罩用于体外循环心内直视术患儿气道管理的效果.方法 择期拟行心内直视术患儿76例,年龄3月～8岁,体重3.3～34.5 kg,性别不限,ASA分级Ⅱ级,心功能分级Ⅰ或Ⅱ级,随机分为2组（n=38）：气管导管组（T组）和ProSeal喉罩组（P组）.麻醉诱导后,T组置入气管导管,P组置入ProSeal喉罩,行机械通气.记录气管导管和喉罩的置入情况、置入时间、最高气道压、术中低氧血症、心动过速、心动过缓、低血压和高血压的发生情况、术后喉头水肿、吞咽困难、呛咳、呼吸困难、声音嘶哑的发生情况.结果 气管导管和ProSeal喉罩全部置入成功.两组术中均未见低氧血症、心动过速、心动过缓、低血压和高血压的发生.与T组比较,P组置入时间缩短,喉头水肿和吞咽困难的发生率降低（P＜0.05）,最高气道压、呛咳、呼吸困难和声音嘶哑的发生率差异无统计学意义（P＞0.05）.结论ProSeal喉罩置入简单易行,可有效保证通气,对咽喉部刺激较小,用于体外循环心内直视术患儿的气道管理安全可靠.

Objective To investigate the use of laryngeal mask airway （LMA） ProSeal for airway management during open heart surgery performed under CPB in children. Methods Seventy-six ASA Ⅱ and NYHA class Ⅰ or Ⅱ patients aged 3 months-8 yr, weighing 3.3-34.5 kg undergoing open heart surgery under CPB were randomly divided into 2 groups （ n = 38 each）： tracheal intubation group （group T） and ProSeal LMA group （group P1）. Tracheal tube and LMA were inserted after induction of anesthesia with 8% sevoflurane. The rate of successfultracheal intubation and LMA placement, placement time, peak airway pressure and side effects during and after surgery including hypoxemia, tachycardia, bradycardia, hypotension and hypertension, laryngesl edema, dysphagia, bucking, dyspnea and hoarseness were recorded. Results There were no significant differences in the rate of successftl tracheal intubation and LMA placement, peak airway pressure, bucking, dyspnea and hoarse voice between the two groups （P〉 0.05）. The LMA placement time was significantly shorter than tracheal intubation time and the incidence of laryngeal edema and dysphagia lower in group P than in group T （ P 〈 0.05）. Conclusion The LMA ProSeal can provide adequate ventilation during operation with less complications and can be used effectively for cardiac surgery performed under CPB in children.