喉罩麻醉与气管插管麻醉对低龄手术患儿肺部感染发生率的影响比较

Effects of laryngeal mask anesthesia versus tracheal intubation anesthesia on the incidence of pulmonary infection in young children subjected to surgery

目的比较气管插管麻醉与喉罩麻醉对低龄手术患儿肺部感染发生率的影响。方法选取杭州市儿童医院2020年1-12月收治的行全身麻醉手术患儿100例为研究对象。采用随机数字表法分为气管插管组和喉罩组,每组50例,比较两组患儿术后24 h呼吸道感染症状(鼻塞、咳嗽、痰鸣音、啰音、排痰)及肺部感染发生率,同时对两组感染病原菌以及围手术期、预后情况进行比较。结果气管插管组患儿鼻塞[56.0%(28/50)]、咳嗽[42.0%(21/50)]、痰鸣音[14.0%(7/50)]、啰音[38.0%(19/50)]、排痰[16.0%(8/50)]等发生率及肺部感染发生率[38.00(19/50)]均显著高于喉罩组患儿[28.0%(14/50)、14.0%(28/50)、4.0%(8/50)、24.0%(12/50)、4.0%(2/50)、6.0%(3/50)](χ^(2)=12.18、21.47,均P<0.001);两组患儿共检出病原菌34株,其中喉罩组4株,气管插管组30株;革兰阳性菌7株(20.6%),革兰阴性菌23株(67.6%),真菌4株(11.8%);两组患儿病原菌组成差异无统计学意义(χ^(2)=1.04,P=0.310);喉罩组患儿苏醒时间[(10.3±3.1)min]及拔管时间[(13.5±2.4)min]均显著短于气管插管组患儿[(16.1±5.1)min、(19.5±4.1)min](t=3.17、7.19,均P<0.05);两组患儿延长住院及非计划再入院率比较,差异均无统计学意义(均P>0.05)。结论喉罩麻醉较气管插管麻醉操作简单,能够显著降低肺部感染发生率,安全性更高,是低龄患儿全身麻醉气道支持方式的首选。本研究具备显著创新性和科学性。

Objective To investigate the effects of endotracheal intubation anesthesia versus laryngeal mask anesthesia on the incidence of pulmonary infection in young children undergoing surgery.Methods A total of 100 young children who underwent surgery under general anesthesia in Hangzhou Children's Hospital from January 2020 to December 2020 were included in this study.They were randomly allocated into the endotracheal intubation anesthesia and laryngeal mask anesthesia groups(n=50/group).The symptoms of respiratory tract infection(nasal congestion,cough,sputum ringing,rale,and sputum excretion)and the incidence of pulmonary infection evaluated 24 hours after surgery were compared between the two groups.At the same time,the pathogens of infection and perioperative conditions as well as prognosis were also compared between the two groups.Results The incidences of nasal obstruction,cough,sputum ringing,rale,sputum excretion,and pulmonary infection were 56.0%(28/50),42.0%(21/50),14.0%(7/50),rale 38.0%(19/50),16.0%(8/50),and 38.00(19/50)respectively in the endotracheal intubation anesthesia group,which were significantly higher than those in the laryngeal mask anesthesia group[28.0%(14/50),14.0%(28/50),4.0%(8/50),24.0%(12/50)4.0%(2/50),6.0%(3/50),χ^(2)=12.18,21.47,all P<0.001].A total of 34 strains of pathogens were detected in the two groups,including 4 strains in the laryngeal mask anesthesia group and 30 strains in the endotracheal intubation anesthesia group.The 34 strains of pathogens included 7 strains of gram-positive bacteria(20.6%),23 strains of gram-negative bacteria(67.6%),and 4 strains of fungi(11.8%).There was no significant difference in pathogen composition between the two groups(χ^(2)=1.04,P=0.310).The time to recovery and the time to extubation in the laryngeal mask anesthesia group were(10.3±3.1)minutes and(13.5±2.4)minutes,which were significantly shorter than those in the endotracheal intubation anesthesia group[(16.1±5.1)minutes,(19.5±4.1)minutes,t=3.17,7.19,both P<0.05].There were no significant differences in the proportion of children who needed prolonged hospitalization and the proportion of children scheduled to undergo readmission between the two groups(both P>0.05).Conclusion Laryngeal mask anesthesia is simpler to operate,remarkably decreases the incidence of pulmonary infection,and is safer compared with endotracheal intubation anesthesia.Therefore,laryngeal mask anesthesia is preferred for general anesthesia for surgery in young children.The study is of great innovation and science.