喉罩在小儿短小手术麻醉中的应用

The clinical application of laryngeal mask in pediatric general anesthesia for minor operations

目的比较喉罩置入与气管内插管用于小儿七氟烷全麻短小手术对血流动力学、呼吸功能的影响。方法将65例ASAⅠ-Ⅱ级,拟在全麻下行择期短小手术的患儿,随机分为气管内插管组(T组,n=32)和喉罩置入组(L组,n=33)。两组患儿麻醉诱导成功后,L组置入喉罩,T组通过喉镜明视置入气管导管。监测记录围麻醉期不同时间点的平均动脉压(MAP)、心率(HR)、脉搏血氧饱和度(SpO2),潮气量(VT)、呼气末二氧化碳分压(PETCO2)。观察记录拔除喉罩/气管导管时有无呛咳、恶心、呕吐、喉痉挛等相关副反应。结果气管内插管组在插管及拔管时的MAP、HR显著高于喉罩组(P<0.01或P<0.05);气管内插管组的副反应显著高于喉罩置入组(P<0.01或P<0.05);SpO2、VT、PETCO2组间比较差异无统计学意义。结论七氟烷全麻小儿短小手术置入喉罩操作简单,通气可靠,对心血管应激反应小,与气管内插管相比不良反应少。

Objective To compare the effects of laryngeal mask airway（LMA） and endotracheal intubation on hemodynamics,respiratory function and stress responses in pediatric general anesthesia for minor operations.Methods Sixty-five pediatric patients,ASAⅠ-Ⅱ,aged 2 to 8 years old,scheduled to do minor operations,were randomly assigned to LMA group（L,n=33） and tracheal intubation group（T,n=32）.After induction LMA or endotracheal tube was inserted in each group.Heart rate（HR）,mean arterial blood pressure（MAP）,tidal volume（VT）,pulse oxygen saturation（SpO2） and end tidal carbon dioxide pressure（PETCO2） were monitored.Side-effects and complications were observed.Results No significant differences were found in VT,SpO2,PETCO2 between the two groups at all observed time points.Hemodynamics was more stable in group L than that in group T during intubation and extubation.The incidence of complication in group L was lower than that in group T（P0.01 or P0.05）.ConclusionCompared with tradition endotracheal intubation,LMA can provides effective ventilation with fewer side effects in pediatric general anesthesia.