小儿斜视矫治术可弯曲喉罩下七氟烷吸入麻醉的效果

Efficacy of flexible laryngeal mask airway and sevoflurane in pediatric strabismus surgery

目的评价可弯曲喉罩通气下七氟烷麻醉用于小儿斜视矫治术的效果。方法择期行斜视矫治术患儿60例，按随机数字表法分为气管导管组和可弯曲喉罩组，每组30例。气管导管组静吸复合麻醉，气管插管，机械通气；可弯曲喉罩组七氟烷麻醉，置入可弯曲喉罩，保留自主呼吸。记录多时点气道峰压和平均气道压。记录气管导管或喉罩置人即刻（T1）、1min（T2）、3min（T3）、5min（T4）和拔出气管导管或喉罩即刻（B）时血压、心率。记录苏醒时间和拔管时间；患儿从苏醒到拔出气管导管或喉罩时呛咳、躁动和术后咽痛的情况及家长的满意度。结果与基础值比较，气管导管组T1时收缩压下降，T2、T3、T4时收缩压升高，T2～T5时心率升高，可弯曲喉罩组T1～T4时收缩压、舒张压下降（P〈0．05）；与气管导管组比较，可弯曲喉罩组T2～T5时收缩压、舒张压、心率均降低（P〈0．05）。气管导管组苏醒时间（8．1±2．6）min．．拔管时间（12．6±3．2）min，从苏醒到拔出气管导管或喉罩时呛咳发生率66．7％（20／30）、咽痛发生率40．0％（12／30）、躁动评分0～1分7例，可弯曲喉罩组分别为（5．2±1．1）min、（6．3±1．5）min、0、6．7％（2／30）、25例，两组比较差异有统计学意义（P〈0．05）。与气管导管组比较，可弯曲喉罩组患儿家长的满意度高，差异有统计学意义（P〈o．05）。结论可弯曲喉罩通气下七氟烷麻醉更适合于小儿斜视矫治术。

Objective To evaluate the efficacy of flexible laryngeal mask airway and sevoflurane in pediatric strabismus surgery. Methods Totally 60 children undergoing elective strabismus surgery were recruited and divided into two groups with 30 cases each by random digits table：group T, in which children accepted endotracheal tube intubation and combined intravenous and inhalation anesthesia with mechanically ventilation;and group F, in which children adopted both flexible laryngeal mask airway and inhalation anesthesia of sevoflurane with spontaneous breath. Airway peak pressure （Ppeak）, average airway pressure （Pmean）, blood pressure （Bp） and heart rate （HR） at induction （Ti）, 1 rain （T2）, 3 min （T3） and 5 min （T4） after induction, removal of endotracheal tube or laryngeal mask airway （Ts）, awaking time and extubation time, occurrence of cough, dysphoria and pharyngodynia from being awake to extubation, satisfaction of patients were recorded. Results When compared to baseline, systolic pressure was lower at T~ and higher at T2, T3 and Ts, and HR was higher at T2-T5 in group T （P 〈 0.05 ）, Bp was lower at T1-T4 in group F （P 〈 0.05 ）. Bp and HR at T2-T5 in group F were lower than those in group T （P 〈 0.05 ）. The awaking time was （8.1±2.6） rain, the extubation time was （ 12.6 ±3.2） min, the occurrence of cough and pharyngodynia was 66.7% （20/30）, 40.0% （12/30）, the dysphofia （0-1 score） was 7 cases in group T,（5.2 ± 1.1） rain, （6.3 ±1.5） min,O,6.7%（2/30）,25 cases in group F. There were significant differences between two groups （P 〈 0.05 ）. The satisfaction of patients in group F was higher than that in group T, there was significant difference between two groups （P 〈 0.05 ）. Conclusion Flexible laryngeal mask airway with sevoflurane could offer high emeacy in pediatric strabismus surgery.