喉罩配合静吸复合麻醉在儿童先天性心脏病介入治疗麻醉管理中的应用

Application of intravenous inhalation compound anesthesia with laryngeal mask in interventional treatment of children with congenital heart disease

目的：观察七氟烷、丙泊酚联合喉罩在儿童先天性心脏病介入治疗麻醉管理应用的临床效果，探讨喉罩应用的安全性。方法择期行先心病介入治疗患儿60例，男28例，女32例，年龄2～6岁，ASAⅠ～Ⅱ级，随机分为气管插管组（Ⅰ组）和喉罩组（Ⅱ组），每组各30例。麻醉用药：Ⅰ组静脉注射芬太尼1μg· kg-1，丙泊酚2．5 mg· kg-1和罗库溴铵0．6 mg· kg-1，气管插管，机械通气；Ⅱ组静脉注射芬太尼1μg· kg -1，丙泊酚2．5 mg· kg-1，并辅以七氟烷吸入，置入喉罩。两组麻醉维持采用丙泊酚6 mg· kg-1· h-1和七氟烷1％～3％。根据血流动力学变化调整输注速度和吸入浓度，Ⅱ组术中保持自主呼吸。记录两组手术时间，麻醉苏醒时间，围术期不同时间点心率（HR），平均动脉压（MAP），脉搏氧饱和度（SpO2）及呼气末二氧化碳（PETCO2）等变化，记录两组患儿发生的心血管事件，术后苏醒质量和并发症等。结果两组患儿手术时间、麻醉诱导前及喉罩或导管置入前、拔除前MAP、HR、SpO2值的实际差值不大；喉罩或导管置入后及术后拔除时Ⅱ组MAP、HR低于Ⅰ组（ P＜0．05），术后呼吸道并发症Ⅱ组明显少于Ⅰ组。结论喉罩应用于儿童先天性心脏病介入治疗全身麻醉管理中，血流动力学平稳，呼吸道并发症少，联合应用丙泊酚、七氟烷等药物，术后恢复快，值得推广。

Objective To discuss the effect and safety use of laryngeal mask anesthesia management in interventional treatment of con -genital heart disease in children .Methods Elective procedures for 60 children with congenital heart disease ,aged 2~6 years,ASAⅠ-Ⅱ,were randomly assigned into two groups：endotracheal intubation group （Ⅰgroup） and laryngeal mask group （Ⅱgroup）,30 cases in each group.Endotracheal intubation was set up following the use of fentanyl 1μg· kg-1 ,propofol 2.5 mg· kg-1 and rocuronium 0.6 mg· kg-1 inⅠgroup;LMA was applied followed by fentanyl 1 μg· kg-1,propofol 2.5 mg· kg-1 and sevoflurane.Parameters MAP, HR and SPO2 were measured and analyzed statistically perioperatively .We observed and compared hemodynamic changes ,intraopera-tive,postoperative adverse reactions ,and recovery time,meanwhile observed the presence of cough ,postoperative laryngeal edema and so on.Results There were no actual differences in operation time ,the value of MAP ,HR and SPO2 before induction and placement or re-moval of LMA and endotracheal tube in two groups .However the values of HR ,MAP were significantly lower in groupⅡthan those in groupⅠafter the insertion and removal of endotracheal tube or LMA （P〈0.05）.Postoperative respiratory complications in groupⅡwere fewer than those inⅠgroup（P〈0.05）.Conclusions Application of LMA in interventional surgical anesthesia of children with con-genital heart disease allows intraoperative hemodynamic stable and fewer respiratory complications ;combined with propofol ,sevoflurane and other drugs can provide rapid postoperative recovery ,which is worth promoting .