喉罩通气全麻在小儿扁桃体摘除术中的应用

Application of laryngeal mask airway general anesthesia in children tonsillectomy

目的探讨喉罩通气用于全身麻醉（全麻）小儿扁桃体摘除术的安全性与效果。方法 60例ASAⅠ~Ⅱ级在全麻下接受扁桃体摘除术的患儿,随机分为喉罩组（A组）和气管插管组（B组）,每组30例。观察两组患儿麻醉诱导前（T0）、插入喉罩/气管导管后即刻（T1）、插入喉罩/气管导管后5 min（T2）、插入喉罩/气管导管后10 min（T3）和拔出喉罩/气管导管后即刻（T4）的SBP、DBP、HR及T2、T3时点的吸气峰压（PIP）和平均气道压（Pmean）,记录术后拔管（喉罩）时间、复苏时间,拔管（喉罩）后气道痉挛、胃胀气、声嘶和低SpO2等并发症的发生率。结果 B组T1、T4时点SBP、DBP、HR较A组及T0时点显著升高（P〈0.05）;T2、T3时点B组PIP和Pmean均高于A组（P〈0.05）。B组拔管时间、复苏时间明显长于A组（P〈0.05）;拔管后气道痉挛、声嘶的发生率明显高于A组,B组胃胀气的发生率低于A组。结论喉罩通气用于全麻小儿扁桃体摘除术具有良好的安全性,且易于维持血流动力学及呼吸动力学稳定,全麻后恢复平稳。

Objective To investigate the safety and efficacy of laryngeal mask airway （LMA） general anesthesia in children tonsillectomy. Methods A total of 60 patients of ASAⅠ~Ⅱstage accepting tonsillectomy under general anesthesia were randomly divided into LMA （group A） and tracheal intubation group （group B）, and each group contained 30 cases. Patients were observed before the induction of anesthesia （T0）, immediately after inserting the LMA/endotracheal tube （T1）, 5 min after LMA/endotracheal tube insertion（T2）, 10 min after the LMA/endotracheal tube insertion （T3） and immediately after （T4） LMA/endotracheal tube patients’SBP, DBP, HR, peak inspiratory pressure （PIP） and mean airway pressure （Pmean） at T2, T3 were viewed. The extubation （LMA） time, recovery time, extubation （LMA） after airway spasm, the incidence of bloating, hoarseness and low SpO2 other complications were recorded. Results Group B T1, T4 point SBP, DBP, HR, compared with group A, was significantly higher than T0 （P〈0.05）;T2, T3 and Pmean point group B PIP were higher than group A （P〈0.05）. The extubation time and recovery time of group B were longer than those of group A （P〈0.05）, the after extubation airway spasm, the incidence of hoarseness were significantly higher than group A, and bloating incidence was lower than the group A. Conclusion Laryngeal mask airway anesthesia for pediatric tonsillectomy has good safety, and is easy to maintain stable hemodynamic, respiratory dynamics and steady recovery after general anesthesia.