儿童七氟烷麻醉下喉罩通气的并发症分析

Observational study of complications connected with the use of the-laryngeal mask airway and sevoflurane anesthesia in children

目的观察不同年龄儿童七氟烷吸入麻醉下喉罩通气的并发症。方法2009年12月至2012年3月择期腹股沟手术160例，年龄1～10岁，美国麻醉医师学会（ASA）分级Ⅰ～Ⅱ，体质量指数14—21kg/m^2。按年龄分为7个月-〈1岁（A组）、1岁～〈3岁（B组）、4岁-（C组）、7岁-（D组）4组。不用术前用药，常规禁食禁饮。采用七氟烷和笑气吸入，在咽喉反射消失、下颌松弛、睫毛反射消失时用翻转法置入。然后进行髂腹下、髂腹股沟神经阻滞。术中不用肌松药，采用自主呼吸。手术结束后拔除喉罩，送入麻醉后复苏室（PACU）。观察手术期间相关的生命体征及手术时间、苏醒时间和Aldrete评分；麻醉过程相关的并发症，包括有无喉罩通气（LMA）移位、多次操作及呛咳、屏气、恶心、呕吐、喉痉挛、体动、一过性的低氧血症[血氧饱和度（SpO2）〈90％]和高CO2血症[呼末二氧化碳（PetCO2）〉50mmHg（1mmHg=0．133kPa）]等；术后有无疼痛、恶心、呕吐、咽喉痛、呼吸抑制等不良反应的发生。结果4组患者性别比、体质指数、手术时间、苏醒时间和Aldrete评分，差异无统计学意义。低氧血症、LMA拔除后舌后坠、恶心、呕吐、咳嗽等情况在各组中均有发生，差异无统计学意义；A组中高CO，血症的发生率高于其余3组；C组中躁动的发生率高于A组和B组；A组和D组屏气的发生率高于B组和C组。结论年龄因素对儿童七氟烷麻醉下喉罩通气并发症是有影响的，〈1岁小儿易于发生呼吸系统并发症，4～6岁的小儿易于发生躁动，在麻醉处理时更应谨慎。

Objective To comparison of the type and the incidence of complications connected with the use of the Laryngeal Mask Airway （LMA） and sevoflurane anesthesia in different ages children. Methods 160 ASA I or II children aged 1 - 10 yrs body mass index （BMI） 14 - 21 undergoing inguinal hernia repair operation were divided into 4 groups according to their ages, 7 m - 1 yrs in group A, 1 - 3 yrs in group B, 4 -6 yrs in group C and 7 - 10 yrs in group D. General anesthesia was induced with sevoflurane and nitrous oxidein （N：O） via a pediatric circle system. No premedication were given. Insertion conditions were noted as satisfactory （jaw relaxed, lash reflex disappeared, no coughing, gagging, swallowing）. LMA were placed using the reverse technique, then ilioinguinal/iliohypogastric nerve blocks were performed. No neuromuscular blocking drugs were used and spontaneous breathing was permitted. LMA were removed after the end of operation, then the patient were sent to post-anaesthesia care unit （PACU）. The time of operation and awakening, vital signs and Aldrete scale were recorded. The incidence of adverse effects （coughing, gross movement, laryngospasm, agitation, nausea, vomiting, sore-throat, respiratory depression, glossoptosis, breathholding and hypercapnia） were also noted. Results There was no significantly difference in four groups about sex, BMI, operation time, the time of awakening and Aldrete score （ P 〉 0. 05 ）. The incidence of hyoxemia, glossoptosis, nausea, vomiting and cough were no significantly difference in four groups, but the incidence of hypercapnia was higher in group A than in other three groups. The incidence of agitation in group C were singnificantly higher than in group A and group B. The incidence of breathholding was higher in group A and group D than in group B and group C. Conclusion The age can influence complications connected with the use of the LMA and sevoflurane anesthesia in children. Respiratory complications is easy to occurred in children less than 1 years. Agitation is especially frequent in children 4 - 6 years.