喉罩全麻在小儿腹腔镜阑尾切除术中的应用

Application of laryngeal mask general anesthesia in pediatric laparoscopic appendectomy

目的比较喉罩和气管插管用于小儿全麻腹腔镜阑尾切除术对患儿的血流动力学、通气功能、气道反应性的影响。方法 30例ASAⅠ~Ⅱ级,年龄4~12岁,其中急诊手术5例,择期手术25例。随机分为喉罩组(Ⅰ组)和气管插管组(Ⅱ组)。记录麻醉诱导前(A1)、诱导后(A2)、插管(罩)后1 min(A3)、气腹后3 min(A4)、拔管(罩)后1 min(A5)等各时点的HR、SPO_2、SBP、DBP、PETCO_2、气道峰压(ppeak),并观察术后相关并发症的发生。结果Ⅰ组A3、A5时的HR、SBP、DBP与Ⅱ组间差异有统计学意义(P<0.05),Ⅱ组拔管时及术后并发症明显多于Ⅰ组(P<0.05)。结论喉罩全麻用于小儿腹腔镜阑尾切除术优于气管插管全麻,易于维持血流动力学稳定,气道反应小,全麻拔管苏醒平稳。

Objective To compare the effects of laryngeal mask and tracheal intubati0n on hemodynamics, ventilation function and airway responsiveness of children undergoing laparoscopic appendectomy in general anesthesia. Methods 30 cases of ASA grade Ⅰ - Ⅱ, aged 4-12 years old, including 5 cases of emergency surgery and 25 cases of elective surgery, were randomly divided into laryngeal maak group （group I ） and tracheal intubation group （group Ⅱ ）. The HR, SPO2, SBP, DBP, PETCO2, airway peak pressure（ppeak） before anesthesia induction（A1）, after induction（A2）, at 1 minute after intubation （A3）, at 3 minutes after pneumoperitoncum （A4）, at 1 minute after extubation （A5） were recorded and the occurrence of postoperative complications were observed. Results There were significant chfferences in HR, SBP, DBP between group l and group Ⅱ at A3 and A5 （P〈0.05）. The compliciations at extubatign and after surgery in group Ⅱ were significantly more than those of group Ⅰ （P〈0.05） Conclusions Laryngeal mask general anesthesia for pediatric laparoscopic appendectomy is superior to tracheal intubation general anesthesia, and the former is easy to maintain hemodynamic stability. The airway reaction of laryngeal mask general anesthesia is low, and patients wake smoothly after general anesthesia extuhation.