喉罩与气管插管对青光眼患儿血流动力学和眼内压影响的比较

Effect of laryngeal mask airway on the haemodynamic changes and intraocular pressure in glaucomatous children compared with tracheal intubation

目的 研究喉罩与气管插管对青光眼患儿血流动力学和眼内压的影响.方法 选取拟择期在全身麻醉下行小梁切开术的青光眼患儿50例,按随机数字表法将患儿分成气管插管组（TT组）和喉罩组,每组25例.分别记录气管插管或置入喉罩的操作时间;咪达唑仑用量;麻醉诱导后（T1）、气管插管或置入喉罩即刻（T2）及气管插管或置入喉罩后1 min（T3）、2min（T4）、3min（T5）、5 min（T）的心率、平均动脉压（MAP）、末梢灌注指数（TPI）和眼内压.结果 两组患儿咪达唑仑用量、操作时间比较差异均无统计学意义（P＞0.05）.与T1比较,TT组T2～T4心率、眼内压升高,T2～T3MAP升高,T2～ T5TPI降低,差异均有统计学意义（P＜0.05）;喉罩组各时点心率、MAP、TPI、眼内压比较差异均无统计学意义（P＞0.05）.喉罩组T2～T4心率、MAP、眼内压低于TT组[心率：（119.3±8.9）、（117.6±8.5）、（115.2±6.9）次/min比（131.3±7.1）、（128.1±6.8）、（123.2±8.6）次/min,MAP：（36.9±5.1）、（37.1±4.8）、（34.7±4.6） mmHg （1mmHg =0.133 kPa）比（44.1±4.9）、（42.8±5.5）、（41.9±7.1）mmHg,眼内压：（27.6±2.5）、（27.0±2.0）、（25.9±2.3） mmHg比（34.2±2.2）、（32.9±1.6）、（31.1±2.2） mmHg],T2～T5TPI高于TT组（3.25±0.28、2.99±0.26、3.15±0.31、3.40±0.30比2.69±0.29、2.22±0.27、2.41±0.30、2.66±0.33）,差异均有统计学意义（P＜0.05）.结论 青光眼患儿全身麻醉下置入喉罩后心率、MAP、TPI和眼内压均未见显著变化,诱导过程平稳,值得临床推广应用.

Objective To compare the response of haemodynamics and intraocular pressure （IOP） to laryngeal mask airway （LMA） and tracheal intubation （TT） in children with glaucoma.Methods A prospective,randomized study was conducted in 50 glaucomatous children,scheduled to undergo trabeculectomy and divided into LMA group （25 cases） and TT group （25 cases） by random digits table method.Endotracheal intubation or placement of the laryngeal mask operation time and the dosage of midazolam was noted in each patient.Heart rate （HR）,mean arterial pressure （MAP）,tip perfusion index （TPI）,IOP were measured after anesthesia induction （T1）,endotracheal intubation or placement laryngeal mask immediately （T2）,endotracheal intubation or placement after laryngeal mask 1 min （T3）,2 min （T4）,3 min（T5）,5 min（T6）.Results There was no significant difference in endotracheal intubation or placement of the laryngeal mask operation time and the dosage of midazolam between two groups （P ＞ 0.05）.Compared with T1,HR,IOP were increased at T2-T4,MAP was increased at T2-T3,TPI was decreased at T2-T5 in TT group,there was significant difference（P ＜ 0.05）.There was no significant difference in HR,MAP,TPI,IOP among different points in LMA group （P ＞ 0.05）.HR,MAP,IOP in LMA group at T2-T4 were lower than those in TT group [HR：（119.3 ±8.9）,（117.6 ±8.5）,（115.2 ±6.9） beats/min vs.（131.3 ±7.1）,（128.1 ±6.8）,（123.2 ± 8.6）beats/min,MAP：（36.9 ± 5.1）,（37.1 ±4.8）,（34.7 ±4.6） mmHg （1 mmHg =0.133 kPa） vs.（44.1 ± 4.9）,（42.8 ± 5.5）,（41.9 ± 7.1） mmHg,IOP：（27.6 ± 2.5）,（27.0 ± 2.0）,（25.9 ± 2.3） mmHg vs.（34.2 ± 2.2）,（32.9 ± 1.6）,（31.1 ± 2.2） mmHg],TPI at T2-T5 was higher than that in TT group （3.25 ± 0.28,2.99 ± 0.26,3.15 ± 0.31,3.40 ± 0.30 vs.2.69 ± 0.29,2.22 ± 0.27,2.41 ± 0.30,2.66 ± 0.33）,and there was significant difference （P ＜0.05）.Conclusion Insertion of LMA in glaucomatous children is not associated with significant changes in haemodynamics and IOP response and offers advantages over tracheal intubation.