口咽通气道联合面罩机械通气在患儿日间手术中的应用

Feasibility and safety of mask combined oropharyngeal ventilation in children anesthesia undergoing day surgery

目的探讨口咽通气道联合面罩通气在患儿日间手术中应用的有效性和安全性。方法：00例日间手术患儿,年龄6～12岁,随机分为两组,分别采用口咽通气道联合面罩通气（M组）和喉罩通气（L组）。静脉输注瑞芬太尼及丙泊酚诱导,术中静脉持续输注瑞芬太尼、丙泊酚维持麻醉。术中维持通气RR 16～20次/分,调节VT,维持PETCO235～40mm Hg。记录诱导前（T1）、置入口咽通气道或喉罩时（T2）、手术开始时（T3）、麻醉用药减半时（T4）、停麻醉用药时（T5）、手术结束时（T6）、拔出口咽通气道或喉罩时（T7）的HR、MAP、SpO2、PETCO2、VT、BIS值及Ppeak。记录置入口咽通气道或喉罩一次成功率,停药至拔出口咽通气道或喉罩时间,自主呼吸恢复良好时间,患儿清醒时间,患儿术后不良反应发生情况。结果两组患儿全部成功完成手术。一次性插入的成功率M组明显高于L组（P〈0.05）。L组术中2例通气不佳,M组无通气不佳患儿。术后患儿有咽部不适感L组11例,M组2例。两组患儿术中HR、MAP、SpO2、PETCO2、VT、BIS值及Ppeak差异无统计学意义。两组PETCO2波形与正常波形比较无变化。术后不良反应及并发症L组明显高于M组（P〈0.05）。结论口咽通气道联合面罩下通气应用于患儿日间手术是安全有效的。

Objective To investigate the feasibility and safety of mask combined oropharyngeal ventilation in pediatric anesthesia undergoing day surgery.Methods One hundred children,aged 6-12 year.underwent day surgery were enrolled and randomly divided into mask combined oropharyngeal ventilation group（group M）and laryngeal mask ventilation group（group L）,with 50 cases each.General anesthesia induction and maintenance with Remifentanil and propofol.Mechanical ventilation by RR 16-20 bpm,adjusting VTto maintain PETCO235-40 mm Hg.The following datas were recorded：HR,MAP,SpO2,PETCO2,VT,BIS and Ppeak at different time,before anesthesia inducement（T1）,insert laryngeal mask or oropharyngeal airway（T2）,operation beginning（T3）,reducing half dose of anesthetic（T4）,stopping anesthetic（T5）,end of operation（T6）,outsert laryngeal mask or oropharyngeal airway（T7）.Success rate to insert laryngeal mask or oropharyngeal airway,time from stopping anesthetic to outsert laryngeal mask or oropharyngeal airway,time of ventilation recovery,awaking time,and postoperative complications were recorded.Results All surgeries completed successfully.Success rate of insert in first attempt was higher in group M than in group L（P〈0.05）.There were2 cases without good ventilation,11 cases with pharyngeal trouble in group L,2cases with pharyngeal trouble in group M.HR,MAP,SpO2,PETCO2,VT,BIS and Ppeak had no significant differences between the two groups.Waveform of PETCO2 was not changed compared with normal in two groups.Group M has less postoperative complications than group L（P〈0.05）.Conclusion Mask combined oropharyngeal ventilation is a safe and effective in children undergoing day surgery.