可弯曲喉罩用于小儿扁桃体摘除术气道管理的效果  

Efficacy of flexible laryngeal mask for airway management in pediatric tonsillectomy

作　　者：李上莹莹 刘阳[1] 于晴[1] 孙茫[1] 夏子玉 钟茜[1] 吕秀兰[1] 涂生芬[1] 

机构地区：[1]重庆医科大学附属儿童医院麻醉科,重庆400014

出　　处：《第三军医大学学报》2016年第23期2522-2526,共5页Journal of Third Military Medical University

基　　金：国家自然科学基金青年科学基金(31200853);重庆市自然科学基金一般项目(CSTC2012jj A10036);重庆市卫计委高端人才后备项目(2015HBRC007)~~

摘　　要：目的 评价可弯曲喉罩用于小儿扁桃体摘除术患者的安全性和有效性。方法择期行扁桃体摘除术患儿30例，年龄2～10岁，体质量10～50 kg, ASA分级Ⅰ～Ⅱ级，采用随机数字表法均分成两组：喉罩组和气管插管组,每组15例。麻醉诱导：喉罩组使用咪达唑仑0.1 mg/kg、丙泊酚3 mg/kg、舒芬太尼 0.5 μg/kg，气管插管组加用顺式阿曲库铵0.15 mg/kg。麻醉维持：两组均使用丙泊酚6～10 mg/（kg·h）、瑞芬太尼0.2～0.5 μg/（kg·min）静脉泵注。记录麻醉诱导前（T0）、麻醉诱导后（T1）、置入喉罩或气管导管即刻（T2）、置入开口器及手术开始即刻（T3）、手术结束时（T4）和拔除喉罩或气管导管即刻（T5）的心率（heart rate,HR）、平均动脉血压（mean arterial pressure, MAP），并于T0、T2、T3、T5采集血样测量血糖和皮质醇浓度；记录麻醉药物用量、液体出入量、麻醉时间、自主呼吸恢复时间、拔管时间、麻醉苏醒时间；并记录置入喉罩或气管插管的首次成功率和总成功率、麻醉恢复期间并发症（躁动、胃胀气、呛咳、喉痉挛等）发生情况。结果与气管插管组比较，喉罩组患儿自主呼吸恢复时间、拔除喉罩时间、苏醒时间明显缩短（P〈0.05）；与T1比较，气管插管组T2的HR、MAP明显升高（P〈0.05），而喉罩组差异无统计学意义，气管插管组T2、T5时刻的HR、MAP明显高于喉罩组（P〈0.05）；喉罩组术后呛咳发生率明显降低（P〈0.05）。结论可弯曲喉罩用于小儿扁桃体摘除术应激反应小，并发症少，安全有效，值得在临床推广应用。Objective To evaluate the safety and effectiveness of flexible laryngeal mask airway in pediatric tonsillectomy. Methods Thirty children of American Society of Anesthesiologists （ASA） Ⅰ～Ⅱ stage, aged 2～10 years old, weighing 10～50 kg, and scheduled for selective tonsillectomy surgery in our department were subjected in this study. They were equally randomized into 2 groups （n=15）, flexible laryngeal mask airway group and tracheal intubation group. Anesthesia induction was carried out with 0.1 mg/kg midazolam, 3 mg/kg propofol, and 0.5 μg/kg sufentanil for the flexible laryngeal mask airway group, and 0.15 mg/kg cis-atracurium was added for the tracheal intubation group. Continuous infusion of 6～10 mg/（kg·h） remifentanil and 0.2～0.5 μg/（kg·min） propofol was used for anesthesia maintenance in the both groups. The values of heart rate （HR） and mean arterial pressure （MAP） in the 2 groups were recorded before- anesthesia induction （T0）, after- anesthesia induction （T1）, inserting the laryngeal mask airway or endotracheal intubation （T2）, placing speculum oris and beginning of the operation （T3）, end of the operation （T4）, and immediately extubation （T5）. Plasma concentrations of glucose and cortisol were detected at T0, T2, T3 and T5. The dosage of anesthetic, liquid intake and output, anesthesia time, spontaneous breathing recovery time, extubation time and consciousness time were recorded. In addition, the success rates of first insertion and total insertion, and occurrences of complications （such as emergence agitation, bloating, bucking, and laryngeal spasm） during the recovery of anesthesia were investigated. Results Compared with the tracheal intubation group, the spontaneous breathing recovery time, extubation time, and consciousness time were obviously shorter in flexible laryngeal mask airway group （P〈0.05）. At T2, the HR and MAP were significantly higher than T1 in the tracheal intubation group （P〈0.05）, but these differences

关 键 词：可弯曲喉罩 气道管理 儿童 扁桃体摘除术 

分 类 号：R197.39[医药卫生—卫生事业管理] R614[医药卫生—公共卫生与预防医学]