小儿疝气手术喉罩全麻不保留呼吸的临床分析

Clinical Analysis of Laryngeal Mask Anesthesia without Keeping Breathe in the Hernia Surgery in Children

目的观察喉罩麻醉不同通气模式用于小儿疝气手术的临床效果。方法方便选取该院(2012年2月—2017年2月间)择期疝囊高位结扎手术患儿48例,年龄3~9岁,ASAⅠ~Ⅱ级,随机分为喉罩全麻不保留呼吸组(N组)和喉罩全麻保留呼吸组(R组),每组24例,比较入室后平静时(T0)、插入喉罩即刻(T1)、切皮时(T2)、牵拉疝囊根部时(T3)和拔出喉罩时(T4)患儿的心率(HR)、血氧饱和度(Sp O2)变化、术中躁动、屏气等不良反应情况。结果 R组在牵拉疝囊根部时(T3)HR(122.1±14.7)与N组(111.1±12.5)相比明显增快(P<0.05),与N组T1、T2、T3同期相比HR均明显增快(P<0.05);R组Sp O2在T2、T3时点与T0及N组同期相比均明显降低(P<0.05)。R组术中2例出现屏气,3例有一过性躁动,不良反应率10.42%,与N组比较麻醉不稳定性明显(P<0.05)。结论不保留呼吸喉罩全麻用于小儿手术麻醉稳定,易调控,安全性强。

Objective To observe the clinical effect of different ventilation modes of laryngeal mask anesthesia in the hernia surgery in children. Methods 48 cases of children with selective hernial sac high ligation from February 2012 to February2017 in our hospital aged from 3 to 9 years old with ASA between Ⅰ and Ⅱwere randomly divided into two groups with 24 cases in each, the N group were the patients with laryngeal mask anesthesia without keeping breathe, while the R group were the patients with laryngeal mask anesthesia keeping breathe, and the changes of HR and Sp O2 changes, intraoperative dysphoria and holding breath were compared at T0 at calm, T1) laryngeal mask insertion without delay, T2 at skin incision,T3 stretching hernial sac and T4 at the laryngeal mask removal were compared between the two groups. Results The HR at T3 was obviously accelerated compared with that in the group N, and the HR was obviously accelerated at T1,T2,T3 compared with that in the group N, and the Sp O2 was obviously decreased at T2 and T3 in eth group R was obviously decreased compared with that in the group N at the same period(P<0.05), and in the group R, there were 2 cases with holding breath,3 cases with transient restlessness and the adverse reaction rate was 10.42%, and the anesthesia instability compared with that in the group N was obvious(P<0.05). Conclusion The laryngeal mask anesthesia without keeping breathe in stabilizing the hernia surgery in children is easy to adjust and the safety is strong.