不同小儿麻醉气道管理方案在围术期上呼吸道感染儿童中的对比

Comparison of different pediatric anesthesia airway management programs in children perioperative upper respiratory tract infections

目的探讨不同小儿麻醉气道管理方案在围术期上呼吸道感染儿童中应用价值。方法选取2012年6月至2013年10月该院收治的200例合并有轻度或中度上呼吸道感染且须行全身麻醉开腹手术患儿,随机分为喉罩组和气管插管组,每组各100例。气管插管组进行气管插管。喉罩组置入合适的ProSeal喉罩,对不同时点的平均动脉压（MAP）、脉搏血氧饱和度（SpO2）、呼气末二氧化碳分压（PetCO2）以及心率等指标进行监测。观察并记录两组患儿在麻醉复苏期出现的并发症以及术后24h的呼吸道感染症状等。结果 T2与T4时点喉罩组心率分别为（113.48±10.21）、（115.24±11.36）次/分,明显低于气管插管组的（123.84±14.22）、（123.96±14.85）次/分,差异均有统计学意义（P〈0.05）;T0-T1、T3、T5时点两组患儿的心率比较,差异均无统计学意义（P〉0.05）;各时点两组患儿在MAP、SpO2以及PetCO2等方面相比较,差异均无统计学意义（P〉0.05）;麻醉复苏期喉罩组患儿低氧血症、术后烦躁、咽喉痛以及喉痉挛等并发症发生率均明显低于气管插管组;喉罩组患儿术后24h的鼻塞、咳嗽、痰鸣音、啰音、喘鸣以及咳痰等上呼吸道感染症状的发生率明显低于气管插管组,差异均有统计学意义（P〈0.05）。结论相比于气管插管,采用喉罩对合并有上呼吸道感染须行开腹手术的患儿进行麻醉气道管理,具有操作相对简单、刺激性小、患儿耐受性好、能够保持心率平稳、麻醉复苏期不良事件的发生率低、术后上呼吸道感染症状轻等方面优点,值得临床推广应用。

Objective To investigate the application value of different pediatric anesthesia airway management programs in children perioperative upper respiratory tract infection.Methods 200 children patients with laparotomy under general anesthesia complicating mild or moderate upper respiratory tract infection in our hospital from June2012 to October 2013 were selected and randomly divided into laryngeal mask（LMA）group and the endotracheal intubation group,100 cases in each group.The endotracheal intubation group took endotracheal intubation.The LMA group took the appropriate ProSeal LMA.The indexes of MAP,SpO2,PetCO2,heart rate（HR）,etc.at different time points were monitored.The complications in the recovery stage of anesthesia and the respiratory infection symptoms appeared at postoperative 24 hwere observed and recorded.Results HR at T2 and T4in the LMA group were（113.48±10.21）beats/min and（115.24±11.36）beats/min respectively,which were significantly lower than123.84±14.22）beats/min,（123.96±14.85）beats/min in the endotracheal intubation group,the differences were statistically significant（P〈0.05）;HR at T0-T1,T3,T5 had no statistical difference between the two groups（P〈0.05）;MAP,SpO2 and PetCO2,etc.at the different time points had no statistical differences between the two groups（P〉0.05）;the occurrence rates of hypoxemia,postoperative irritability,sore throat,larynx spasms and other complications during anesthesia recovery period in the LMA group were significantly lower than those in the endotracheal intubation group with statistical differences（P〈0.05）;the upper respiratory tract infection symptoms such as nasal congestion,cough,wheezy phlegm,rales,wheezing and sputum at postoperative 24 hin the LMA group were significantly lower than those in the endotracheal intubation group,the differences were statistically significant（P〈0.05）.Conclusion Compared with endotracheal intubation,conducting the anesthesia airway management by using the laryngeal mask in children patients with general anesthesia laparotomy complicating upper respiratory tract infections has the significant advantages of relatively simple operation,small irritation,and good children tolerance,remaining stable HR,low occurrence rate of adverse events in the recovery stage of anesthesia and mild symptoms of postoperative respiratory infection.