喉罩全麻控制呼吸在患儿纤维支气管镜手术中的应用

The application of controlled ventilation with the laryngeal mask airway under general anesthesia in fiberoptic bronchoscopy in children

目的 比较喉罩全麻下控制呼吸与自主呼吸在患儿纤维支气管镜手术中的应用效果及安全性.方法 选择择期行纤维支气管镜检查及介入治疗的住院患儿60例,随机均分为控制呼吸组（C组）和自主呼吸组（S组）.C组患儿喉罩置入成功后给予顺苯磺酸阿曲库铵0.2 mg/kg,行控制呼吸;S组患儿喉罩置入成功后保留自主呼吸,必要时手控辅助通气.观察并记录诱导前5 min（T0）、置人喉罩即刻（T1）、手术开始即刻（T2）、手术开始5 min （T3）及拔除喉罩即刻（T4）的HR、MAP、SpO2、PETCO2,记录T1～T4时的VT,并采集桡动脉血行血气分析.记录手术时间、苏醒时间、手术中断次数、瑞芬太尼的用量、术中及术后呛咳、憋气等不良反应的发生情况,调查内镜医师满意度.结果 与S组比较,C组手术时间明显缩短（P＜0.05）,手术中断次数明显减少（P＜0.01）,瑞芬太尼的用量明显增多（P＜0.01）.C组内镜医师的满意度明显高于S组（P＜0.01）.与S组比较,T2、T3时C组HR明显减慢（P＜0.01）,MAP、PETCO2、PaCO2、HCO3-明显降低（P＜0.05或P＜0.01）,pH值、PaO2、BE、SaO2、SpO2、VT明显升高（P＜0.05或P＜0.0l）.与T0时比较,T2、T3时C组PETCO2明显降低（P＜0.05）,T3时S组PETCO2明显升高（P＜0.05）.与T1时比较,T2、T3时C组VT明显升高（P＜0.01）,S组VT明显降低（P＜0.01）,两组PaO2明显升高（P＜0.05或P＜0.01）,S组PaCO2明显升高（P＜0.05）.与S组比较,C组术中呛咳、憋气和肢体运动发生率明显降低（P＜0.05或P＜0.01）.结论 喉罩全麻控制呼吸在患儿纤维支气管镜手术中的应用效果可靠、安全有效,不良反应少,医师满意度高,值得在临床上推广应用.

Objective To compare the efficacy and safety of spontaneously breathing or controlled ventilation with laryngeal mask airway （LMA） in fiberoptic bronchoscopy in children.Methods Sixty children undergoing fiberoptic bronchoscopy were randomized into two groups：group C （controlled ventilation） and group S （spontaneous breath）.After successful LMA insertion,group C received intravenous injection of cisatracurium at a dose of 0.2 mg/kg,while group S had spontaneous breath and assistant ventilation if necessary.The values of HR,MAP,SpO2,PETCO2,VTand blood gas analysis from radial artery were recorded 5 min before anesthesia induction （T0）,during LMA insertion （T1）,at the beginning and 5 min after operation （T2 and T3）,and during LMA removal （T4）.In addition,the operation time,recovery time,interruption times,dosage of remifentanil,times of intra-/post-operative bucking and breath holding and operator＇s satisfaction were also investigated.Results Compared with group S,the operation time,times of interruption were decreased,the dosage of remifentanil and operator＇s satisfaction index were increased （P〈0.05or P〈0.01）.Compared with group S at T2 and T3,HR,MAP,PETCO2,PaCO2 and HCO3-in group C were significantly decreased,and pH,PaO2,BE,SaO2,SpO2 and VT were significantly increased （P〈0.05 or P〈0.01）.Compared with T0,the PETCO2 at T2 and T3 in group C was significantly decreased,while at Ts in group S was significantly increased （P〈0.05）.Compared with T1,the VT at T2 and T3 in group C was increased,while in group S was decreased.The PaO2 was increased significantly in two groups,and the PaCO2 in group S was significantly increased （P〈0.05or P〈0.01）.Compared with group S,the frequency of bucking,breath holding and body movement were decreased in group C （P 〈0.05 or P 〈0.01）.Conclusion Controlled ventilation with LMA under general anesthesia in fiberoptic bronchoscopy in children was reliable,safe and effective anesthetic method with less adverse reaction and more satisfaction.It is worthy of spreading to clinical use.