可弯曲喉罩在小儿俯卧位手术中的应用

Application of flexible laryngeal mask airway in pediatric surgery in prone position

目的观察可弯曲喉罩(FLMA)在小儿俯卧位手术中的应用效果。方法 2014年10月至2016年10月在安徽省儿童医院行全麻下俯卧位手术患儿40例,采用随机数字表法分为可弯曲喉罩组(FLMA组)和气管导管组(ETT组),每组20例。记录患儿入室(T1)、插管即刻(T2)、插管后1 min(T3)、拔管后1 min(T4)各时点血压、心率;记录仰卧位、俯卧位气道峰压;记录两种卧位时纤维支气管镜下喉罩位置分级;记录手术时间、拔管(喉罩)时间以及气道痉挛、返流误吸、漏气等不良反应。结果两组患儿仰卧位下均一次成功插入气管导管或喉罩,翻身俯卧位完成手术。T3、T4时点,FLMA组平均动脉压(65. 90±9. 36)、(72. 40±11. 09) mm Hg显著低于ETT组(80. 80±9. 73)、(86. 40±9. 04) mm Hg(P <0. 01);心率(103. 95±10. 00)、(107. 00±7. 55)次/分,显著低于ETT组(119. 35±8. 48)、(129. 15±7. 87)次/分(P <0. 01);两组俯卧位气道峰压(15. 25±1. 33)、(17. 00±1. 30) cm H2O均高于平卧位(12. 70±1. 38)、(14. 10±1. 41) cm H2O(P <0. 05);俯卧位纤维支气管镜下喉罩位置4级(只见声门)例数少于仰卧位(P <0. 05);拔管时间FLMA组(5. 25±1. 71) min短于ETT组(6. 95±2. 11) min(P <0. 05); FLMA组术中有2例出现漏气,经加深麻醉后缓解。结论可弯曲喉罩用于小儿俯卧位短时(<2 h)手术的气道管理,通气良好,血流动力学平稳,拔管时间短。

Objective To investigate the efficacy of flexible laryngeal mask airway(FLMA)for the airway mangement in children undergoing surgery in prone position.Methods Forty hospitalized children scheduled to undergo surgery in prone position were included and assigned into group FLMA or group ETT.The value of the heart rate(HR),mean arterial pressure(MAP)of the two groups were recorded before anesthesia induction(T 1),at the moment before intubation(T 2),at 1min after intubation(T 3)and at 1min after extubation(T 4).The peak airway pressure in supine position and prone position was compared.The final position of the LMA was determined with a fiberscope and graded in both supine position and prone position.The operation time,extubation time and the incidence rate of adverse events such as laryngospasm,aspiration,airway leaking were also recorded.Results The tracheal incubation and laryngeal mask airway were inserted in the first attempt in all children.Compared with group ETT,the value of MAP in group FLMA were significantly lower at T 3 and T 4(P<0.01).The value of HR in group FLMA were also significantly lower at T 3 and T 4(P<0.01).During mechanical ventilation,the peak airway pressure was significantly higher in prone position than that in supine position(P<0.05).Sixteen children had fiberoptic bronchoscopy(FOB)grade 4 in supine position while eleven in prone position.The extubation time was significantly shorter in group FLMA than that in group ETT(P<0.05).Conclusion In the airway management of children undergoing short time(<2 h)surgery in prone position,FLMA is an effective respiratory mechanics,with the advantages of hemodynamic stability and rapid recovery.