加强型喉罩用于小儿扁桃体腺样体切除术的效果及安全性

The effect and safety of reinforced laryngeal mask airway in pediatric adenotonsillectomy

目的 探讨加强型喉罩用于小儿扁桃体腺样体切除术的效果及安全性.方法 选择择期行扁桃体腺样体切除术的住院患儿60例,年龄4～12岁.采用随机数字表法均分为喉罩组（L组）和气管插管组（T组）.观察并记录诱导前5 min（T0）、插入喉罩或气管插管时（T1）、置开口器时（T2）、手术开始时（T3）及拔除喉罩或气管插管前（T4）的HR、MAP、SpO2;记录T1～T4时的VT、PET CO2及T1～T3时的气道峰压（Ppeak）;记录喉罩或气管插管首次插入成功率和总成功率、手术时间、苏醒时间、丙泊酚和瑞芬太尼的用量,并记录术中及术后呛咳、喉痉挛、反流误吸及苏醒期躁动等不良反应的发生情况.结果 L组患儿苏醒时间明显短于T组（P＜0.05）;与T组比较,T1、T2、T4时L组HR明显减慢,T1时L组MAP明显降低（P＜0.05或P＜0.01）;与T0时比较,T1、T2、T4时T组HR明显增快（P＜0.05）;而两组SpQ、VT、PETCC2、Rpeak比较差异均无统计学意义;与T组比较,L组术后呛咳、苏醒期躁动发生率明显降低（P＜0.01或P＜0.05）,而两组喉罩或气管插管首次成功率和总成功率、丙泊酚用量、瑞芬太尼用量、喉痉挛及反流误吸的发生率差异均无统计学意义.结论 加强型喉罩用于小儿扁桃体腺样体切除术中,可保持气道通畅,获得良好的通气效果,血流动力学平稳,苏醒时间短,不良反应少.因此其用于该类手术中安全有效,值得在临床上推广应用.

Objective To evaluate the effects and safety of reinforced laryngeal mask airway in pediatric adenotonsillectomy.Methods Sixty hospitalized children aged 4-12 years old,scheduled for selective adenotonsillectomy surgery under general anesthesia were equally randomized into two groups：group L （reinforced laryngeal mask airway） and group T（tracheal intubation）.The values of HR,MAP,SpO2 in two groups were recorded at 5 min before anesthesia induction （T0）,inserting the laryngeal mask airway or endotracheal intubation （T1）,placing speculum oris（T2）,the beginning of operation （T3）,and before extubation （T4）.Keep notes on VT,PETCO2 at T1-T4 and Ppeak at T1-T3.In addition,the success rate of first insertion and total insertion,duration of operation and recov ery,dosage of propofol and remifentanil,and the times of intra-/post-operative bucking,laryngeal spasm,regurgitation and aspiration and emergence agitation were also investigated.Results The recovery time in group L was obviously shortened （P＜0.05）.Compared with group T,the value of HR slowed significantly at T1,T2 and T4,and the value of MAP of group L was obviously lower at T1 （P＜0.05 or P＜0.01）.In group T the value of HR was significantly faster than T0 at T1,T2,and T4 （P＜0.05）,while SpO2,VT,PETCO2 and Ppeak had no statistically significant difference in the interior group and inter group.Compared with group T,the rate of post operation bucking and emergence agitatin in group L was significantly decreased （P＜0.01 or P＜0.05）,while the success rate of first insertion and total insertion,dosage of propofol and remifentanil,laryngeal spasm,regurgitation and aspiration had no statistically significant difference.Conclusion The application of reinforced laryngeal mask airway in adenotonsillectomy in pediatric can keep the airway unobstructed and has good ventilation effect,stable hemodynamics,shorten palinesthesia time and less adverse reaction.Therefore,using the reinforced laryngeal mask airway to this kind of surgery is perfectly safe and effective.It is worthy of spreading to clinical use.