I-gel喉罩和Ambu喉罩用于1岁以下婴儿全身麻醉的比较  

A comparison of airway management between laryngeal mask airway-I-gel and laryngeal mask airwayAmbu in infants under one-year-old with general anesthesia

作　　者：顾志清[1] 刘珺珺[1] 金泉英[1] 陈莲华[2] 

机构地区：[1]上海交通大学附属儿童医院麻醉科,上海200040 [2]上海交通大学附属第一人民医院麻醉科

出　　处：《上海医学》2015年第8期629-634,共6页Shanghai Medical Journal

摘　　要：目的通过比较1岁以下婴儿使用I-gel喉罩或Ambu喉罩的通气效果，评价这两款喉罩用于婴儿全身麻醉气道管理的有效性和安全性。方法选择0～1岁择期于泌尿外科行会阴部手术的患儿30例，采用抽签法随机分为I-gel喉罩组和Ambu喉罩组，每组15例。观察并记录两组患儿的喉罩置入情况，包括置入成功率、成功置入喉罩所需时间（张口开始至行正常机械通气的时间）、喉罩置入成功后的Brimacombe评分。分别于麻醉诱导后（T0）、成功置入喉罩后呼气末二氧化碳分压（PetCO2）正常时（T1）、置入后10min（T2）、置入后20min（T3）、置入后30min（T4）各时间点，记录血流动力学数据，于T1至T4时间点记录气道密封压（LP）和呼吸动力学数据，计算每千克体重吸入潮气量、呼出潮气量、漏气分数（Lf）和呼气阻力（Re）。记录喉罩置人后患儿的不良反应发生情况。结果两组患儿喉罩置人成功率和喉罩成功置入后Brimacombe评分的差异均无统计学意义（P值均〉O．05），I-gel喉罩组成功置人喉罩所需时间显著短于Ambu喉罩组（P〈0．05）。Fgel喉罩组T1至T4时间点的LP均显著高于Ambu喉罩组（P值均〈0．05）。两组患儿各时间点的平均动脉压、心率、脉博血氧饱和度的差异均无统计学意义（P值均〉0．05）。Ambu喉罩组T1至T4时间点的呼气峰流速均显著高于I-gel喉罩组同时间点（P值分别〈0．01、0．05），呼气阻力均显著低于I-gel喉罩组同时间点（P值分别〈0．01、0．05）；Ambu喉罩组T1时间点的吸入潮气量、呼出潮气量、肺动态顺应性、肺静态顺应性均显著高于I-gel喉罩组同时间点（P值分别〈0．05、0．01）。Ambu喉罩组患儿胃胀气发生率显著高于I-gel组（P〈0．05），两组间其他不良反应发生率的差异均无统计学意义（P值均〉0．05）。结论I-gel喉罩和Ambu喉罩均能满足1岁以下婴儿全�Objective To compare the safety and efficacy between laryngeal mask airway-l-gel （LMA-I- gel） and laryngeal mask airway-Ambu （LMA-Ambu） during general anesthesia in infants less than one year old. Methods Thirty infants, aged less than one year, undergoing perineal surgical procedures were randomly divided into two groups by sortition （n = 15）. LMA-I-geI and LMA-Ambu were inserted in the two groups, respectively. Inserting time, achievement ratio of insertion, and fiber optic bronchoscope （FOB） classification were recorded. Hemodynamic data were measured after induction of anesthesia （T0）, when partial pressure of carbon dioxide in endexpiratory gas （PaC02） was normal after insertion （T1）, and 10 min （T2）, 20 min （T3）, 30 min （T4） after intubation. Airway leakage pressure （LP） and parameters for respiratory mechanics were recorded at the time points of T1 -T4 . The inspiratory or expiratory tidal volume per kilogram body weight （VTin/kg, VTex/kg）, leakage fraction （Lf）, expiratory resistance （ Re）, dynamic compliance （ Cdyn）, and static compliance （Cst） werecalculated. The complications were also recorded after insertion. Results There were no significant differences in the achievement ratio of insertion or FOB classification between two groups （both P〉0.05）. The inserting time in the LMA-I-gel group was significantly shorter than that in the LMA-Ambu group （P〈0.05）. The LP at T1-T4 in the LMA-I-gel group were significantly higher those that in the LMA-Ambu group （all P〈0. 05）. There were no significant differences in the mean artery pressure （MAP）, heart rate （HR） or saturation pulse oxygen （SpO2） at any time point between groups （all P〉O. 05）. At T1 -T4, the peak expiratory pressure （PEF） in the LMA-Ambu group were significantly higher than those in the LMA-I-gel group （P〈0.01 or 0.05）, while the Re in the LMA- Ambu group were significantly lower than those in the LMA-I-gel group （ P〈0.01 or 0.05）

关 键 词：I-gel喉罩 Ambu喉罩 呼吸动力学 婴儿 

分 类 号：R726.1[医药卫生—儿科]