小儿先天性心脏病介入治疗术麻醉中喉罩的应用  

The application of laryngeal mask airway for general anesthesia in the interventional therapy of children with congenital heart disease

作　　者：程加文[1,2] 王晓亮[3] 赵倩[3] 史宏伟[3] 

机构地区：[1]淮安市仁慈医院麻醉科 [2]徐州医学院附属淮安医院麻醉科,江苏淮安223002 [3]南京医科大学附属南京第一医院麻醉科,江苏南京210006

出　　处：《南京医科大学学报（自然科学版）》2011年第11期1695-1697,共3页Journal of Nanjing Medical University(Natural Sciences)

摘　　要：目的:与传统的气管插管(TT)方法作比较,探讨喉罩(LMA)在小儿先天性心脏病介入治疗术麻醉中的应用效果。方法:选择美国麻醉师协会(ASA)评分Ⅰ～Ⅱ级,先天性心脏病介入治疗的患儿60例,随机分为2组:喉罩组(LMA组,30例)和气管插管组(TT组,30例)。LMA组全麻诱导静脉给予丙泊酚1.5 mg/kg和雷米芬太尼2μg/kg,在药物完全起效后行LMA置入。TT组全麻诱导时加用肌松药罗库溴铵0.6 mg/kg。麻醉维持采用丙泊酚和雷米芬太尼持续输注。分别记录两组患儿手术时间、苏醒时间、麻醉诱导前、LMA或TT置入前、置入后以及拔除前、后的平均动脉压(MAP)、心率(HR)、血氧饱和度(SpO2)的数值,并对置入LMA或TT的一次成功率进行比较,监测术毕麻醉恢复情况。结果:两组患儿手术时间、苏醒时间、麻醉诱导前及LMA或TT置入前、拔除前的MAP、HR、SpO2值相比较无统计学差异(P>0.05),而在置入后和术后拔除LMA或TT时LMA组的MAP、HR低于TT组(P<0.05),术后呼吸系统并发症LMA组少于TT组(P<0.05)。结论:喉罩下全身麻醉用于小儿先天性心脏病介入治疗,与气管插管全麻相比,患儿血流动力学平稳,术后呼吸系统并发症少。Objective： To explore the effects of the laryngeal mask airway（LMA） and the traditional endotracheal intubation（TT） in general anesthesia children with congenital heart disease.Methods： Sirty children（ASA Ⅰ～Ⅱ） with congenital heart disorders,were randomly divided into two groups：laryngeal mask airway group（LMA group,30 cases） and endotracheal intubation group（TT group,30 cases）.LMA was inserted following the intravenous infusion of propofol（1.5 mg/kg） and remifentanil（2 μg/kg） in LMA group,while in TT group endotracheal intubation was set up following the intravenous administration of propofol（1.5 mg/kg）,remifentanil（2 μg/kg） and rocuronium（0.6 mg/kg）.Anesthesia was maintained with propofol and remifentanil micro pump infusion,intermittent intravenous rocuronium.The length of time for operation and recovery from anaesthesia in two groups were recorded,and the values of MAP,HR,SpO2 at different time points（before anaesthesia induction,before insection of LMA or TT,immediately after insection of LMA or TT,before and after the removal of LMA or TT） were observed.Meanwhile,the successful rate of first placement was compared in two groups.Results： There were no significant differences between the two groups in the length of time for operation and recovery from anaesthesia（P 0.05）,as well as the values of MAP,HR,SpO2 before induction,before insection and before remove of LMA or TT（P 0.05）.However,the values of MAP,HR,SpO2 were significantly higher in TT group than those in LMA group immediately after insection and after removal of LMA or TT（P 0.05）.The incidence of postoperative respiratory complications in LMA group was significantly lower than that in TT group.Conclusion： Application of laryngeal mask airway for general anesthesia in the interventional therapy of children with congenital heart disease could not only achieve an effect of hemodynamic-stabilization,but also reduce postoperative respiratory complications because of its less stress

关 键 词：小儿 先天性心脏病 介入治疗 喉罩 全身麻醉 

分 类 号：R614.2[医药卫生—麻醉学]