Bailey手法在小儿电子耳蜗植入术后苏醒期气道管理中的安全性和有效性

Safety and efficacy of Bailey manoeuvre for airway management during the recovery period in pediatric patients undergoing cochlear implantation

目的评价Bailey手法在小儿电子耳蜗植入术后麻醉苏醒期气道管理的安全性和有效性。方法 50例ASA I^II级择期行电子耳蜗植入手术的先天性聋患儿在麻醉苏醒期随机分为Bailey手法喉罩导气管(laryngeal mask airway,LMA)组(n=25)和气管插管(endo tracheal tube,ETT)组(n=25)。记录两组患儿拔管/罩时的呛咳反应和拔管后脉搏血氧饱和度(pulse oxygen saturation,SpO_2)的情况。记录患儿各时间点的血流动力学数据:麻醉前(T0)、拔管/罩前即刻(T_1)、拔管/罩后即刻(T_2)。结果苏醒期LMA组和ETT组呛咳发生率分别为12%和80%(P<0.000 1);拔管后1 min LMA组平均SpO_2高于ETT组(P<0.05)。LMA组患儿拔管后无低氧发生,ETT组1例患儿出现重度呛咳及短暂SpO_2下降至89%。LMA组患儿T_1和T_2时平均动脉压(mean arterial pressure,MAP)低于T0时(P<0.05);ETT组患儿T_2时心率(heart rate,HR)及MAP较T0时显著升高(P<0.05),T_1和T_2时ETT组MAP和HR均显著高于LMA组(P<0.05)。结论 Bailey手法用于小儿麻醉苏醒期气道管理可有效避免拔管时呛咳和低氧状态,并有利于维持血流动力学稳定。

Objective To evaluate the safety and efficacy of the laryngeal mask airway（Bailey manoeuvre）for airway management during the postanaesthetic recovery period in pediatric patients undergoing cochlear implantation. Methods Fifty pediatric patients were enrolled and randomly assigned to receive either a laryngeal mask airway（LMA,n=25）or a endo tracheal tube（ETT,n=25）during the recovery period after electric cochlear implantation.The extent of coughing and pluse oxygen saturation（SpO_2）were recorded.Hemodynamic profiles was recorded at different time points：baseline（T_0）,before extubation（T_1）and after extubation immediately（T2）. Results In LMA group,the incidence of coughing was lower than that in ETT group（12%vs.80%,P〈0.000 1）,The median SpO_2 at the 1st min after extubation in LMA group was higher than that in ETT group（P〈0.05）.No patient presented oxygen desaturation after extubation in LMA group.In ETT group,one child experienced transient oxygen desaturation（89%）because of severe coughing.Mean arterial pressure（MAP）at T_1 and T_2 were both significantly less than those at T_0 in LMA group（P〈0.05）.In ETT group,MAP and HR at T_2 was significantly higher than those at T_0（P〈0.05）.MAP and HR were significantly higher in ETT group than those in LMA group at T_1 and T_2（P〈0.05）. Conclusions The Bailey manoeuvre provided less coughing,higher median SpO_2 and more stable hemodynamic profiles when compared with the endo tracheal tube in the postanaesthetic recovery period.