喉罩与气管导管用于1～3岁小儿全麻手术中对应激反应影响的差异性比较

The effect of laryngeal mask versus that of endotracheal tube on stress response in children age 1 to 3 during surgery with general anesthesia

目的观察和比较喉罩与气管导管应用于1—3岁小儿全麻手术中对应激反应的影响。方法择期行腹腔镜疝囊高位结扎术的患儿100例，手术时间为上午8：00～11：00，年龄1-3岁；将其随机分为A组（喉罩组）和B组（气管导管组），采用7％七氟烷、芬太尼、维库溴胺、异丙酚诱导，A组置人喉罩，B组采用喉镜经El明视插入气管导管。观察并记录诱导前（TO）、插入喉罩或气管导管后即刻（T1）、及其后2min（T2）、5min（T3）和拔管后即刻（T4）的MBP、HR的变化及血浆皮质醇水平（Cor）。采用SPSS13．0软件包进行统计学分析。结果MBP、HR变化：（1）A组，与TO相比，T1、T2、T3、T4时差异无显著性（P〉0．05）；（2）B组，T1、T2较T0明显升高；T3稍下降，与T0比，升高仍有显著性（P〈0．05）；（3硅且间比较，T0时两组差异无显著性（P〉0．05），B组T1、T2、T3、T4时均较同时段A组水平高，差异有显著性（P〈0．05）。皮质醇水平：（1）A组，与T0相比，T1、T2、T3、T4、时无明显变化，差异无显著性（P〉0．05）；（2）B组，与T0相比，皮质醇水平T1、T2、T3、T4时有明显升高，差异有显著性（P〈0．05）；（3）组间比较，T0时两组差异无显著性（P〉0．05），B组T1、T2、T3、T4时皮质醇水平均较同时段A组皮质醇水平升高，差异有显著性（P〈0．05）.结论喉罩用于1～3岁小儿全麻引起的应激反应明显小于气管导管组。

Objective To compare the effect of laryngeal mask with that of endotracheal tube on stress response in children age 1 to 3 during surgery with general anesthesia. Methods 100 children age 1 to 3 who received selective laparoscopic hernia sac high ligation were randomly divided into group A （ laryngeal mask ）and group B （ endotracheal tube ）. In both groups, 7% sevoflurane, fentanyl, vecuronium bromine amine, and propofol were used for induction of general anesthesia. Laryngeal mask was placed in group A while endotracheal tube was used in group B. Changes in MBP and HR and plasma cortisol levels were observed and recorded efore induction （ T0 ）, immediately after inserting a laryngeal mask or endotracheal tube （ T1 ）, 2 minutes later （ T2 ）, 5 minutes later （ T3 ）, and immediately after removing the laryngeal mask or endotracbeal tube （ T4 ）. The SPSS 13.0 software was used for statistical analysis. Results The changes in MBP and HR did not differ in group A between TO and T1, T2, T3, and T4 （ P 〈 0.05 ） MBP and HR were markedly elevated at TI and T2 in group B as compared with those at TO and were slightly lower at T3 but were still higher than those at TO, the difference being sgnificant （ P〈 0.05 ）. There were no significant differences in MBP and HR at TO btween group A and group B; while at the other time points, MBP and HR were markedly higher than in group B than in group A （ P 〈 0.05 ）. Plasma cortisol levels did not differ significantly in group A between TO and T1, T2, T3, and T4 （ P 〉 0.05 ）;, in group B, the levels of plasma cortisol at T1, T2, T3, and T4 were significantly higher than those at TO （ P 〈 0.05 ）. There were no significant differences in cortisol levels btween group A and group B at TO; while at the other time points, cortisol levels were higher in group B than in group A （ P 〈 0.05 ）. Conclusions Laryngeal mask causes less stress response induced by general anesthesia than eudotracheal tube does in children age 1 to 3.