七氟烷诱导麻醉下喉罩与气管插管在婴幼儿颌面部血管畸形介入手术中的效果比较

Comparison of laryngeal mask and endotracheal intubation under sevoflurane induced anesthesia in interventional surgery of maxillofacial vascular malformation in infants

目的:通过对患有颌面部血管畸形的婴幼儿在七氟烷吸入诱导麻醉后使用气管插管或喉罩的观察比较,明确此类患儿接受全麻手术时采用的安全合理的通气方法。方法:选择2020年1—6月于上海交通大学医学院附属第九人民医院施行颌面部血管畸形介入手术的患儿80例,分为喉罩组(A组)和气管插管组(B组),每组40例。采用七氟烷诱导麻醉,比较2组患儿麻醉诱导前(T0)、诱导后(T1)、插管后即刻(T2)、手术开始时(T3)、术毕(T4)、拔管后1 min(T5)的心率(HR)和平均动脉压(MAP)。统计2组患儿的手术时间、苏醒时间(停止麻醉给药到拔管时间)和出手术室时间。观察2组患儿躁动、呛咳、误吸、恶心、呕吐、声嘶、咽喉痛的发生情况。采用SPSS 26.0软件包对数据进行统计学分析。结果:A组各个时间点HR和MAP比较无统计学差异,B组插管后、拔管后HR和MAP显著高于诱导前,且显著高于A组患儿相应时间点(P<0.05)。2组患儿的手术时间、苏醒时间和出手术室时间无统计学差异(P>0.05)。B组躁动、呛咳发生率显著高于A组(P<0.05)。结论:采用七氟烷吸入诱导麻醉后置入喉罩或进行气管插管,均能顺利完成婴幼儿颌面部血管畸形介入手术。喉罩麻醉具有血流动力学稳定、术后并发症少等优点,是一种安全、有效、迅捷的麻醉方法。

PURPOSE:By observing and comparing the use of endotracheal intubation or laryngeal mask after sevoflurane inhalation induced anesthesia in infants with maxillofacial vascular malformation,to evaluate what kind of safe and reasonable ventilation methods should be used in these children undergoing general anesthesia.METHODS:From January 2020 to June 2020,80 children with maxillofacial vascular malformation undergoing interventional surgery at Shanghai Ninth People's Hospital Shanghai Jiao Tong University School of Medicine were selected and divided into laryngeal mask group(group A,n=40)and endotracheal intubation group(group B,n=40).Heart rate(HR)and mean artery pressure(MAP)were measured pre-induction of anesthesia(T0),after induction of anesthesia(T1),immediately after intubation(T2),at the beginning of operation(T3),at the end of operation(T4)and 1 min after extubation(T5).The operation time,recovery time(time from stopping anesthesia to extubation)and the time out of the operating room of the two groups were counted.The occurrence of restlessness,cough,aspiration,nausea and vomiting,hoarseness and sore throat were observed.Statistical analysis was performed using SPSS 26.0 software package.RESULTS:There was no significant difference in HR and MAP at each time point in group A.The HR and MAP after intubation and extubation in group B were significantly higher than those before induction,and higher than those at corresponding time points in group A(P<0.05).There was no significant difference in operation time,recovery time and the time out of the operating room between the two groups(P>0.05).The incidence of restlessness and cough in group B was significantly higher than that in group A(P<0.05).CONCLUSIUNS:Laryngeal mask or endotracheal intubation after sevoflurane inhalation induced anesthesia can successfully complete interventional operation of maxillofacial vascular malformation in infants.Laryngeal mask anesthesia has the advantages of stable hemodynamics and fewer postoperative complications,which is a safe,effective and rapid anesthesia method.