可弯曲喉罩与气管导管在儿童腺样体扁桃体切除术中应用的对比研究

Comparison between flexible laryngeal mask airway and tracheal intubation in children undergoing adenoidectomy and tonsillectomy

目的比较可弯曲喉罩(FLMA)与气管导管(ETT)在儿童腺样体扁桃体切除术中应用的可行性和安全性。方法选择静吸复合全身麻醉下择期行小儿鼾症腺样体扁桃体切除手术的患儿40例,随机均分为FLMA组和ETT组。麻醉诱导后分别置入FLMA/ETT。记录诱导前(T0)、置入后1(T1)、3(T2)、5 min(T3)、拔出后1(T4)、3 min(T5)的心率(HR)、脉搏氧饱和度(SpO2)、平均动脉压(MAP);记录置入FLMA/ETT后5 min(T6),置入开口器后10(T7)、20 min(T8),移除开口器后5 min(T9)的呼吸动力学指标:气道峰压(P peak)、平均气道压(P mean)、呼末二氧化碳分压(PetCO2),记录1次置入成功率,返流和误吸发生率,拔管时和拔管后呛咳、喉痉挛、喘鸣、躁动的发生情况;观察术后24 h内不良反应发生率。结果 ETT组T1、T2、T3、T4、T5时MAP,HR均高于T0及FLMA组(P<0.05)。FLMA组T1、T2、T3、T4、T5时MAP,HR较T0时略有升高,但差异无统计学意义。P peak、P mean在ETT组高于FLMA组(P<0.05)。ETT组拔管时间较FLMA组明显延长且较多术后并发症(P<0.05)。结论与传统的ETT相比,在不影响外科操作的前提下,FLMA通气体现出诱导及麻醉过程中血流动力学及呼吸动力学平稳,苏醒期血流动力学平稳,无明显呛咳躁动,出血少;气道损伤少,术后咽痛率低,舒适度提高。

Objective To compare the eficacy and safety of flexible laryngeal mask （FLMA） and endotracheal tube （ErI＇T） in children undergoing adenoideetomy and tonsillectomy. Methods Forty children with snoring disease scheduled for selective adenoidectomy and tonsillectomy surgery under intravenous compound inhalation general anesthesia were divided randomly into either FLMA group or ETT group. MAP, HR and SpO： were recorded before anesthesia induction （ T0） , 1 （ T1 ） ,3 （ T2） ,5 （ T3 ） rain after intubation, 1 （ T4 ）, 3 （ T5 ） min after extubation. Parameters for respiratory mechanics included peak airway pressure （Pp^ak）, mean airway pressure （P ）, end tidal COx （ PetCO2 ）, and airway sealing pressure. All of the above indicators were recorded 5 rain （ T6 ） after intubation, 10 （T7 ） ,20 （W8 ） min after put in mouth gag,5 （W9 ） rain after removing mouth gag. Meanwhile, ehievement ratio of first time insertion, incidence of regurgitation aspiration, bucking, laryngospasm, wheezing when extubation and af- ter extubation, anesthesia time, surgery time, extubation time were recorded. Complications such as nausea and vomiting, pharyngeal pain, hoarseness were followed up 24 hours after surgery. Results MAP, HR during T1 , T2, T3 , Ta,T5 were significantly higher in group T than T0, and those in group FLMA （P 〈 0.05）. MAP, HR were not significantly changed in group FLMA during each time. Ppeak, P was significantly lower in group FLMA than that in group ETT. The extubation time was shorter and the incidence of coughing and pharyngalgia after operation was lower in group FLMA than that in group ETT. Conclusion Compared with endotraeheal intubation, on the basis of not affecting surgical operation, FLMA is an effective, safe anesthesia for adenoidectomy and tonsillectomy surgery in children, with the advantages of hemodynamic stability, mild airway trauma, and is a easy handling method, with minor laryngeal stimulation during intubation and extubation, more stable hemodynamics, reliable respiratory mechanics and low incidence of postoperative upper airway complications.