喉罩通气下吸入地氟醚麻醉维持在婴幼儿颜面部混合血管瘤介入手术中的应用

Application of laryngeal mask airway inhalated with desflurane anesthesia in the interventional treatment of infant facial superficial mixed hemangioma

目的探讨喉罩通气下吸入地氟醚麻醉维持在婴幼儿颜面部混合血管瘤介入手术中的应用效果。方法回顾性分析2016年2月至2017年4月本院收治的118例颜面部混合血管瘤介入手术治疗的婴幼儿(3~15个月)临床资料,按麻醉方式差异分为对照组(51例)和观察组(67例),2组患儿均给予舒芬太尼麻醉,对照组以喉罩通气下丙泊酚维持,观察组给予喉罩通气下吸入地氟醚维持。比较2组患儿平均动脉压MAP、脉搏血氧饱和度Sp O2、心率HR、呼吸末二氧化碳ETCO2、喉罩拔除时间、失去意识时间、喉罩拔除时间、意识复苏时长、临床疗效及术中术后不良反应等麻醉监测指标的差异。结果对照组患儿的喉罩拔除时间、意识复苏时长明显长于观察组患儿,2组比较差异具有统计学意义(P<0.05);在麻醉诱导后、喉罩插入时刻、手术开始时刻和拔除喉罩时刻,观察组和对照组患儿的MAP、HR均低于麻醉诱导前,且对照组患儿的MAP、HR均低于观察组,2组比较差异具有统计学意义(P<0.05);观察组治疗总有效率(97.02%)显著高于对照组(88.24%),对照组患儿不良反应率(23.52%)显著高于观察组(7.46%),2组比较差异均具有统计学意义(P<0.05)。结论患儿颜面部混合血管瘤介入手术中,喉罩通气下吸入地氟醚进行麻醉维持,在有效保障麻醉效果及临床疗效的同时,还可降低麻醉风险,减小术中血压波动,尤其在稳定患儿血流动力学方面的效果突出。

Objective To investigate the application effect of interventional surgery in the treatment of facial superficial mixed hemangioma through the laryngeal mask ventilation under desflurane anesthesia. Methods In the period from February 2016 to April 2017 in our hospital 118 cases of facial superficial hemangioma under interventional surgery in infants（ aged 3-15 months） were retrospectively analyzed;according to the difference of anesthesia,they were divided into control group（ 51 cases） and observation group（ 67 cases）; the two groups of children were administered sufentanil anesthesia,in the control group laryngeal mask airway under propofol,the observation group was given under laryngeal mask airway inhalation of desflurane maintenance. Then was compared the difference in anesthesia monitoring indexes of the two groups,such as mean arterial pressure（ MAP）,saturation of pulse oximetry（ Sp O2）,heart rate（ HR）,end-tidal carbon dioxide（ ETCO2）,laryngeal mask removal time,loss of consciousness time,laryngeal mask removal time,consciousness recovery duration,clinical efficacy and intraoperative and postoperative adverse reactions difference. Results For the control group,the laryngeal mask removal time and consciousness recovery time length were significantly longer than those of the observation group and the difference was statistically significant（ P〈0. 05）; after anesthesia induction,the laryngeal mask insertion time,operation start time and laryngeal mask removal time,MAP and HR of the observation group and the control group were lower than those before anesthesia induction,and MAP and HR of control group were lower than those of the observation group and the deference was statistically significant（ P〈 0. 05）. The total efficiency of the observation group（ 97. 02%） was significantly higher than the control group（ 88. 24%）,the adverse reaction rate（ 23. 52%） of children in the control group was significantly higher than that（ 7. 46%） of those in the observation group,and the differences were statistically significant（ P〈 0. 05）. Conclusion In the infant facial superficial hemangioma interventional surgery,laryngeal mask airway can be used for anesthesia maintenance for desflurane effect and clinical curative effect in the effective protection of anesthesia at the same time,but also can reduce the risk of anesthesia and intraoperative blood pressure fluctuations,especially in the stabilization of hemodynamics of the patients.