喉罩在新生儿腹腔镜疝囊高位结扎术中的应用

Application of laryngeal mask in neonatal laparoscopic hernia sac high ligation surgery

目的观察喉罩应用于新生儿腹腔镜下疝囊高位结扎术麻醉的临床效果。方法行腹腔镜疝囊高位结扎术的新生儿100例,出生2～28d,男86例,女14例,体重3.1～4.8kg,随机均分为喉罩组(L组)和气管插管组(T组)。术中吸入七氟醚维持麻醉。观察患儿入室时、插管(喉罩)时、手术开始5min和拔管(喉罩)时的HR、MAP,记录术后拔管(喉罩)时间、拔管(喉罩)后气道痉挛、恶心干呕、咽部红肿、声嘶和低SpO2等并发症的发生率;通过麻醉机电子挥发罐余量显示来计算两组患儿七氟醚消耗量。结果 L组患儿的插喉罩时、手术开始5min和拔喉罩时的HR明显快于、MAP明显低于T组(P<0.01)。L组拔喉罩时间明显短于T组(P<0.01),拔喉罩后呼吸道并发症以及七氟醚消耗量均低于T组(P<0.05)。结论喉罩应用于新生儿腹腔镜手术的麻醉安全可靠,较气管插管全麻用药少,拔管后并发症少,麻醉更为平稳。

Objective To observe the effect of Laryngeal Mask Airway（LMA） for airway management in neonatal laparoscopit hernia ligation. Methods One hundred ASA Ⅰ or Ⅱ neonatal cases, aged 2-28 d weighting 3.1-4. 8 kg undergoing laparoseopic high ligation of hernia sac were randomly divided into 2 groups, group LMA（group L, n=50） and group tracheal intubation（group T, n： 50）. There were 86 boys and 14 girls respectively. Anesthsia was maintained by sevoflurane inhalation. Haemodynamics（HR, MAP） at the time of pre-intubation, tracheal intubation, 5 win after the operation beginning and extubation, extubation time, postoperative complications including airway spasns, nausea and vomiting, pharyngeal red and swollen, hoarseness and low SpO2 and consumption of sevoflurane were recorded. Reslllts Compared with group T, HR was higher and MAP was lower in group L at tracheal intubation, 5 min after the operation beginning and extubation （P〈0. 01）. Extubation time of group L was shorter than that of group T （P 〈 0. 01 ）; The respiratory tract complications after extnhation and consumption of sevoflurane in group L were significantly less than those in group T （P〈 0. 05 ）. Conclusion LMA in neonatal laparoscopic hernia sac high ligation is a safe method, accompanied by less anesthetic drugs consumption and respiratory complications compared with tracheal intubation.