蛇形喉周通气道和喉罩用于儿科患者的随机前瞻性研究  

作　　者：Peter Szmuk Oscar Ghelber Maria Matuszczak Marry F. Rabb Tiberiu Ezri Daniel I. Sessler 高梅(译) 钱燕宁(校) 

机构地区：[1]Department of Anesthesiology, University of Texas Southwestern Medical School and Children's Medical Center at Dallas, Texas [2]Department of Anesthesiology, University of Texas Medical School at Houston, Texas [3]Department of Anesthesia, Wolfson Medical Center, Holon, Affiliated to Tel Aviv University, Israel [4]Department of Outcomes Research, The Cleveland Clinic, Ohio [5]Member Outcomes Research Consortium [6]不详

出　　处：《麻醉与镇痛》2010年第1期42-49,共8页Anesthesia & Analgesia

摘　　要：背景蛇形喉周通气道（CobraPLA）在成人正压通气时，密封压力优于单纯喉罩（LMAU），本研究旨在比较两者在婴儿和儿童中的使用效果。方法200例小儿患者随机分为CobraPLA组和LMAU组，测量套囊充气压力为40和60cmH2O时气道的密封效果，插入的难易度和时间，手术后咽痛、发声困难、喉痉挛、支气管痉挛和胃内胀气的发生率，间断测量CobraPLA端和麻醉呼吸回路Y型接口处的呼气末二氧化碳浓度（ETCO2）。对主要转归指标，各组又分为小型号和大型号CobraPLA及LMAU亚组进行分析。结果以均数±标准差表示，P〈0．05表示有显著性差异。结果套囊充气压为60cmH2O时，大型号CobraPLA亚组的气道密封压力（22±7cmH2O）明显高于小型号CobraPLA亚组（18±5cmH2O）及大型号LMAU亚组（16±5cmH2O）（P〈0．001）；CobraPLA组比LMAU组更不易移位（手术前和手术后的解剖合适度评分相同），气体入胃也少；CobraPLA头端ETCO，测量值比Y型接口处高6．4±6mmHg。结论从大多数参数分析来看，CobraPLA与LMAU在儿科患者麻醉中的作用相当，某些方面优于后者。BACKGROUND： The Cobra Perilaryngeal Airway （PLA） provides better sealing pressure than the Laryngeal Mask Airway Unique （LMAU） during positive-pressure ventilation in adults. We compared the performance of the CobraPLA and LMAU in infants and children. METHODS： Two-hundred pediatric patients were randomly assigned to a CobraPLA or an Laryngeal Mask Airway （LMA）. We measured airway sealing at cuff inflation pressures of 40 and 60 cm H2O; ease and time of insertion; device stability; efficacy of ventilation; number of insertion attempts; incidence of post- operative sore throat, dysphonia, laryngospasm, bronchospasm, and gastric gas insufflation. Steady-state end-tidal CO2 was measured at the head of the CobraPLA and at the ＂Y-piece＂ piece of the anesthetic circuit. For the major outcomes, the airway groups were subdivided post hoc into small and large CobraPLA and small and large LMA subgroups. Results are presented as means ± SDs; P 〈 0.05 was considered statistically significant. RESULTS： Airway sealing pressure with the cuff inflated to 60 cm H2O in the large CobraPLA subgroup （22 ±7 cm H2O） was significantly more than that of the small CobraPLA subgroup （18 ± 5 cm H2O） and large LMA subgroup （16 ±5 crn H2O, 19 〈 0.001 ）. The CobraPLA was more stable than the LMA （same anatomic fit score before and after surgery） and produced less gastric insufflation. Head CobraPLA end-tidal CO2 values were 6.4 ±6 mm Hg more than those of the Y piece of the circle circuit. CONCLUSIONS： The CobraPLA airway performed as well as the LMAU during anesthesia in pediatric patients for a large range of outcomes and was superior for some.

关 键 词：随机前瞻性研究 儿科患者 通气道 喉罩 蛇形 呼气末二氧化碳浓度 充气压力 支气管痉挛 

分 类 号：R657.4[医药卫生—外科学] R473.72[医药卫生—临床医学]