ProSeal^(TM)喉罩通气道应用于超快通道小儿心脏麻醉的可行性  

Feasibility of Using ProSeal^(TM) Laryngeal Mask Airway in Ultra-Fast-Track Pediatric Cardiac Anesthesia

作　　者：肖文静[1] 晏馥霞[1] 李巅远[2] 闫军[2] 李守军[2] 胡盛寿[2] 李立环[1] 

机构地区：[1]中国医学科学院阜外心血管病医院麻醉科,北京100037 [2]中国医学科学院阜外心血管病医院心脏外科,北京100037

出　　处：《实用儿科临床杂志》2010年第11期798-800,共3页Journal of Applied Clinical Pediatrics

基　　金："十一.五"国家科技支撑计划项目(2006BAI01A08)

摘　　要：目的探讨ProSealTM喉罩通气道(PLMA)应用于超快通道小儿心脏麻醉的可行性和安全性。方法选取实施择期心脏手术的患儿40例,年龄6个月～5岁,均为美国麻醉医师协会(ASA)身体状况分级Ⅱ级。患儿按体质量分为2组,Ⅰ组(20例):体质量5～10kg,插入1.5号PLMA;Ⅱ组(20例):体质量>10～20kg,插入2.0号PLMA。采用80mL.L-1七氟烷实施吸入麻醉诱导,采用持续静脉泵入瑞芬太尼和异丙酚及吸入七氟烷维持麻醉,静脉应用维库溴铵维持肌肉松弛。结果术中全部患儿采用容量控制通气,并能达到设定的潮气量而无漏气。插入PLMA后,患儿总呼吸道峰压为(15.8±4.2)cmH2O(1cmH2O=0.098kPa);Ⅰ组插入PLMA后呼吸道峰压明显高于Ⅱ组[(18.9±3.8)cmH2Ovs(12.8±1.7)cmH2O,P<0.05]。Ⅱ组PLMA插入后的呼吸道峰压明显低于胸骨闭合后[(12.8±1.7)cmH2Ovs(16.5±3.8)cmH2O,P<0.05]。停机前,全部患儿肺复张膨肺采用的呼吸道压为25～35cmH2O,肺复张满意,且无脱离体外循环后低氧血症。全部患儿在手术室内拔除PLMA,PLMA使用的平均时间为(174.7±30.9)min。虽然拔出PLMA前后的脑电双频指数、血压和心率变化比较差异有统计学意义,但各参数的变化均小于10%。术后X线胸片检查无异常。结论 PLMA应用于超快通道小儿心脏手术麻醉是可行且相对安全的。Objective To explore the feasibility and safety of using ProSealTM laryngeal mask airway （PLMA） in ultra - fast - track pediatric cardiac anesthesia. Methods Forty children [ American Society of Anesthesiologists（ASA） Ⅱ ,aged from 6 months to 5 years old ] were scheduled for undergoing cardiac operation, and were divided into 2 groups. In group I [ n = 20, weight （5 - 10） kg ] ,a size 1.5 PLMA was used, and in group Ⅱ [ n = 20, weight （ 〉 10 - 20 ） kg ], a size 2.0 PLMA was used, respectively. Anesthesia was induced with inhalation of 80 mL · L-1 sevoflurane and maintained with infusion of remifentanil and propofol and inhalation of sevoflurane. Muscle relaxation was maintained by intravenous administration of vecuronium. Results All children were ventilated with a tidal volume of 10 mL · kg- 1 without air leak. Average peak airway pressure for all children was （ 15.8 ±4.2） cmH20. Average peak airway pressure in group I was higher than that in group Ⅱ after insertion [ （ 18. 9± 3.8 ） cmH20 vs （ 12.8± 1.7 ） cmH2 O, respectively （ P 〈 0.05 ） ]. In group Ⅱ , the peak airway pressure after insertion was significantly lower following sternal closure[ （ 12.8 ± 1.7 ） cmH2O vs （ 16.5± 3.8 ） cmH20, respectively （ P 〈 0.05 ） ]. Lung inflation at pressure of 25 -35 cmH20 for alveolar recruitment was efficient during weaning off cardopulmonary bypass and no hypoxia occurred after cardopulmonary bypass. The average placement time of PLMA was （ 174.7 _＋ 30.9 ） min. Although the difference was significant, the changes in hemodynamics and bispectral index were less than 10% before and after removal of PLMA. Postoperative chest X - ray was normal. Conclusion PLMA is feasible and relatively safe for pediatric cardiac patients undergoing ultra - fast - track anesthesia.

关 键 词：ProSealTM喉罩通气道 超快通道小儿心脏手术 全身麻醉 体外循环 

分 类 号：R726.1[医药卫生—儿科]