置入食管引流型喉罩和经典喉罩对小儿伤害性刺激程度的比较

Comparison of noxious stimulations induced by insertion of Proseal laryngeal mask airway and classic laryngeal mask airway in children

目的比较置入食管引流型喉罩（PLMA）与经典喉罩（CLMA）对小儿伤害性刺激的程度。方法择期全麻手术患儿47例，性别不限，年龄3～12岁，体重11—36kg，ASA分级Ⅰ或Ⅱ级，采用随机数字表法，将患儿随机分为PLMA组（n=23）和CLMA组（n=24）。采用序贯法进行试验，靶控输注异丙酚行麻醉诱导，待效应室浓度与预设的血浆靶浓度平衡后置入喉罩。PLMA组和CLMA组首例患儿异丙酚血浆靶浓度分别设为6．0和4．4μg／ml，存在喉罩置入反应，则下一例患儿异丙酚血浆靶浓度升高1个浓度梯度，无喉罩置入反应，则下一例患儿异丙酚血浆靶浓度降低1个浓度梯度，浓度梯度为0．29g／ml。喉罩置入反应的标准为：下颌松弛困难无法置入、置入即刻、置入后1min内出现呛咳、吞咽、肢体运动、屏气或喉痉挛。计算异丙酚抑制喉罩置入反应的半数有效血浆靶浓度及其95％置信区间。结果异丙酚抑制小儿PLMA和CLMA置入反应的半数有效血浆靶浓度及其95％置信区间分别为5．87（5．62～6．11）和4．53（4．38～4．69）μg／ml，差异有统计学意义（P〈0．01）。结论置入PLMA对3～12岁小儿的伤害性刺激程度较CLMA增强。

Objective To compare the noxious stimulations induced by insertion of Proseal laryngeal mask airway （PLMA） and classic laryngeal mask airway （CLMA） in children. Methods Forty-seven ASA Ⅰ or Ⅱ children, aged 3 - 12 yr and undergoing surgery under general anesthesia, were randomly divided into 2 groups： PLMA group （group P, n = 23） and CLMA group （group C, n = 24）. General anesthesia was induced with target-controlled infusion （TCI） of propofol. When the effect-site concentration of propofol was equal to the plasma concentration predetermined, PLMA or CLMA insertion was attempted. The target plasma concentration of propofol was predetermined according to Dixon＇s up-down method, with 0.2 μg/ml as a step size. The initial target plasma concentration of propofol was 6 t^g/ml and 4.4 μg/ml for groups P and C, respectively. The predetermined target plasma concentration of propofol and the satisfaction of insertion conditions for each child were recorded. Results The 50% effective concentration （EC50） of propofol to achieve satisfied condition of PLMA and CLMA insertion were 5.87 （95 % CI, 5.62-6.11 ） and 4.53 （95 % CI, 4.38-4.69）μg/ml, respectively, and the difference was significant （ P 〈 0.01 ）. Conclusion The noxious stimulation induced by insertion of PLMA in children aged 3-12 years is stronger than that of CLMA.