旋头45°位对行腹腔镜手术患儿食管引流型喉罩气道密闭性和咽喉部并发症的影响

Influences of rotation 45° position on airway sealing and complications of ProSeal laryngeal mask in children undergoing laparoscopy

目的观察腹腔镜手术中采用旋头45°位对患儿食管引流型喉罩(ProSeal laryngeal mask airway, PLMA)气道密闭性和咽喉部并发症的影响,探讨其有效性和安全性。方法行腹腔镜手术患儿200例,随机分为旋头位组和正头位组各100例。旋头位组采用正头位放置PLMA后,改为右旋头45°位;正头位组采用正头位放置PLMA后,保持正头位至手术结束。记录2组性别、年龄、体质量、ASA分级、麻醉时间、手术时间、PLMA漏气发生情况、漏气压、潮气量、气道峰压、气道平台压、呼气末二氧化碳分压、纤维支气管镜评分以及术中喉罩移位、胃胀气、反流/误吸、拔出喉罩24 h内咽喉部并发症发生情况,并进行比较。结果旋头位组性别比例、年龄、体质量、ASA分级、麻醉时间、手术时间与正头位组比较差异均无统计学意义(P>0.05)。旋头位组漏气压[(21.7±3.2)cm H_(2)O]、气道峰压[(14.0±2.0)cm H_(2)O]、气道平台压[(10.8±2.8)cm H_(2)O]、呼气末二氧化碳分压[(37.4±3.5)cm H_(2)O]、纤维支气管镜评分>3级比率(1.0%)均低于正头位组[(22.5±3.4)cm H_(2)O、(16.9±2.2)cm H_(2)O、(13.1±3.9)cm H_(2)O、(38.8±4.9)cm H_(2)O、8.0%](P<0.05),PLMA漏气发生率(5.1%)、潮气量[(143.9±35.1)mL]与正头位组[3.0%、(145.7±34.4)mL]比较差异均无统计学意义(P>0.05)。旋头位组术中喉罩移位发生率(1.0%)低于正头位组(8.0%)(P<0.05),胃胀气(0)、反流/误吸(0)及拔出喉罩24 h内咽喉部并发症(17.2%)发生率与正头位组(2.0%、1.0、18.0%)比较差异均无统计学意义(P>0.05)。结论行腹腔镜手术患儿术中采用旋头45°位不影响有效通气,可降低PLMA漏气压,减少喉罩移位,且不增加胃胀气、反流/误吸及咽喉部并发症发生率,安全性高。

Objective To observe the influences of rotation 45° position on airway sealing and laryngeal complications of ProSeal laryngeal mask(PLMA) in children undergoing laparoscopy. Methods Totally 200 children undergoing laparoscopy were randomly and equally divided to rotation group and neutral group. After the PLMA was placed, the children in neutral group maintained median head position till the end of operation, and the children in rotation group changed to rotation 45° neck position. The gender, age, body mass, ASA grade, anesthesia time, operation lasting time, incidence of air leakage, oropharyngeal leakage pressure, tidal volume, peak airway pressure, platform airway pressure, partial pressure of end-tidal carbon dioxide, fiber bronchoscopy score, and incidences of PLMA displacement, gas distention, reflux/aspiration and laryngeal complications in 24 h after removing PLMA were recorded and compared between two groups. Results There were no significant differences in the gender, age, body mass, ASA grade, anesthesia time and operation lasting time between two groups(P>0.05). The leakage pressure [(21.7±3.2) cm H_(2)O], peak airway pressure [(14.0±2.0) cm H_(2)O], platform airway pressure [(10.8±2.8) cm H_(2)O], partial pressure of end-tidal carbon dioxide concentration [(37.4±3.5) cm H_(2)O], and percentage of fiber bronchoscopy score > 3(1.0%) in rotation group were lower than those in neutral group [(22.5±3.4) cm H_(2)O,(16.9±2.2) cm H_(2)O,(13.1±3.9) cm H_(2)O,(38.8±4.9) cm H_(2)O, 8.0%](P<0.05). There were no significant differences in PLMA leakage rate and tidal volume between rotation group [5.1%,(143.9±35.1) mL] and neutral group [3.0%,(145.7±34.4) mL](P>0.05). The incidence of PLMA displacement was lower in rotation group(1.0%) than that in neutral group(8.0%)(P<0.05),and there were no significant differences in the incidences of gas distention,reflux/aspiration and laryngeal complications between rotation group(0,0,17.2%)and neutral group(2.0%,1.0,18.0%)(P>0.05).Conclusions Rotation 45°neck position can reduce the leakage pressure of PLMA in children undergoing laparoscopy,but not influence the effective ventilation.It may reduce the risk of PLMA displacement without increasing the incidences of gas distention,reflux/aspiration and laryngeal complications,and its safety is high.