喉罩用于气道狭窄患儿先天性心脏病矫形术气道管理的效果  

Efficacy of laryngeal mask airway for airway management during surgical correction of congenital heart disease in pediatric patients with airway stenosis

作　　者：张全意[1] 丁洁[1] 王嵘[1] 王宇红[1] 张浩[2] 闫军[2] 李守军[2] 晏馥霞[1] 

机构地区：[1]中国医学科学院北京协和医学院阜外心血管病医院麻醉科,100037 [2]中国医学科学院北京协和医学院阜外心血管病医院小儿外科中心,100037

出　　处：《中华麻醉学杂志》2016年第6期736-739,共4页Chinese Journal of Anesthesiology

摘　　要：目的评价喉罩用于气道狭窄患儿先天性心脏病矫形术气道管理的效果。方法择期在体外循环下行先天性心脏病矫形术的气道狭窄患儿16例，性别不限，ASA分级Ⅰ或Ⅱ级，年龄4月～5岁，体重6～14kg。患儿均采用喉罩通气下静吸复合全麻。记录喉罩置入时间、机械通气20min时气道阻力和喉罩漏气情况；分别于置入喉罩5min（T1）、停CBP 10min（T2）和拔除喉罩后5min（T3）时进行血气分析，记录pH值、PaCO2和乳酸水平；记录喉罩拔除时间、拔除喉罩时咽喉粘膜损伤情况、术后再次气管插管、恶心呕吐和返流误吸的发生情况、ICU停留时间和术后出院时间等指标。结果术前CT证实气道狭窄患儿5例，术中气管插管时发现气道狭窄患儿11例。喉罩置入时间为（1．3±0．4）min，置入喉罩后未见明显漏气发生。机械通气20min时气道阻力为（15±4）cmH2O2。所有患儿均顺利拔出喉罩，喉罩拔出时间为（8．1±1．3）min，未见黏膜损伤、恶心呕吐及返流误吸的发生。术后ICU停留时间为20（31）h，术后出院时间为7（1）d，术后均未进行再次气管插管。与T1比较，T3时pH值降低，T2，3时PaCO2升高，T2时乳酸水平升高（P〈0．05）。结论喉罩可安全、有效地用于气道狭窄患儿先天性心脏病矫形术的气道管理。Objective To evaluate the efficacy of laryngeal mask airway （LMA） for airway management during surgical correction of congenital heart disease in the pediatric patients with airway stenosis. Methods Sixteen pediatric patients of both sexes with airway stenosis, of American Society of Anesthesiologists physical status I or II , aged 4 months-5 yr, weighing 6-14 kg, scheduled for elective surgical correction of congenital heart disease under cardiopuhnonary bypass, were enrolled. LMA was inserted, and combined intravenous-inhalational anesthesia was performed in all the pediatric patients. The time of LMA insertion, and airway resistance and air leakage of LMA at 20 rain of mechanical ventilation were recorded. At 5 rain after LMA insertion （ Tl ） , 10 rain after termination of cardiopulmonary bypass （ T2 ） , and 5 min after removal of LMA （T3 ） , blood gas analysis was performed, and the pH value, partial pressure of arterial carbon dioxide and lactic acid level were recorded. The indices such as the time of removal of LMA, damage to the laryngeal mucosa during removal of LMA, occurrence of postsurgical re-intubation, nausea and vomiting, and regurgitation of gastric contents, duration of intensive care unit stay, and postsurgical discharge time were recorded. Results Five cases with airway stenosis were confirmed by computed tomo- graphy before surgery, and 11 cases with airway stenosis were found when intubated during surgery. The time of LMA insertion was（1.3±0.4） min, and no air leakage was observed after LMA insertion. The airway resistance was （15±4） cmH2O at 20 rain of mechanical ventilation. All the pediatric patients were extubated successfully, the time of extubation was （ 8. 1± 1.3） rain, and the damage to the laryngeal mucosa, nausea and vomiting, and regurgitation of gastric contents were not observed. The duration of intensive care unit stay was 20 （31） h, postsurgical discharge time was 7 （1） d, and no patients required re-intubation after surgery. Compared wit

关 键 词：喉面罩 心脏缺血 先天性 气道阻塞 呼吸 人工 

分 类 号：R726.1[医药卫生—儿科]