喉罩全麻控制通气在小儿无痛纤维支气管镜检查中的应用

The application of general anesthesia with improved laryngeal mask in fiberoptic bronchoscopy in children

目的比较喉罩联合T型密封接头静脉全麻控制通气和静脉全麻保留自主呼吸两种麻醉方法在小儿无痛纤维支气管镜检查中的效果及安全性。方法将2008年6月～2010年6月,年龄2～8岁,拟行纤支镜检查的40例患儿随机分为喉罩全麻控制通气组(L组,n=20)、静脉全麻组(C组,n=20)。L组患儿通过喉罩联合T型密封接头控制通气,C组患儿在常规静脉全麻下行纤支镜检查,保留患儿自主呼吸,必要时经面罩辅助通气。观察两组患儿心率(HR)、平均动脉压(MAP)及脉搏血氧饱和度(SpO2)的变化,记录检查中呛咳、憋气或肢体运动等不良反应发生情况,调查内镜医师满意度。结果 C组患儿HR、MAP在镜检过程中明显升高,SpO2明显下降(P<0.01),而L组患儿的HR、MAP及SpO2无明显变化。C组患儿检查中呛咳、憋气或肢体运动等不良反应发生率明显高于L组(P<0.05),L组内镜医师的满意度明显高于C组(P<0.01)。结论喉罩联合T型密封接头全麻控制通气用于小儿无痛纤维支气管镜检查安全、有效,不良反应少,有很好的临床应用价值。

Objective To evaluate the clinical effect and safety of general anesthesia with laryngeal mask airway in fiberoptic bronchoscopy in children.Methods Forty children,aged 2-8 years,scheduled for fiberoptic bronchoscopy were randomly divided into 2 groups（n= 20 in each）： controlled ventilation group by laryngeal mask airway combined with T-seal adapter（Group L） and total intravenous anesthesia with spontaneous respiration（Group C）.The patients in group c could receive assisted ventilation via face mask if necessary.Fiberoptic bronchoscopy in group C was carried out after surface anesthesia.The improved laryngeal mask was inserted and controlled respiration was performed during the period of fiberoptic bronchoscopy.The heart rate（HR）,mean arterial pressure（MAP） and pulse oxygen saturation（SpO2） were recorded before,during and after the fiberoptic bronchoscopy.The side effects such as irritating cough,breathlessness,the movement of the limbs and the satisfaction of doctors were also observed.Results The HR and MAP were significantly higher in the group C than those in the group L during inspection（P0.01）,the SpO2 was obviously decreased during the fiberoptic bronchoscopy（P0.01）.There were less irritating cough,breathlessness,and body movement in group L（P0.05）.The satisfaction of doctor was significantly higher in the group L than that in group C（P0.01）.Conclusion It is a safe and effective alternative to painless fiberoptic bronchoscopy of controlled ventilation with laryngeal mask airway and T-seal adapter in children.