膈肌超声指导小儿腹股沟疝修补术拔除喉罩时机的效果分析  

Analysis of the effect of diaphragm ultrasound guidance on the timing of laryngeal mask removal in pediatric inguinal hernia repair

作　　者：刘杰[1] 王涛[1] 姜丽华[1] 侯银龙 高文龙 董正华[1] LIU Jie;WANG Tao;JIANG Lihua;HOU Yinlong;GAO Wenlong;DONG Zhenghua(Department of Anesthesiology,the Third Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第三附属医院麻醉科,郑州450052

出　　处：《实用医学杂志》2023年第16期2085-2089,共5页The Journal of Practical Medicine

基　　金：河南省医学科技攻关计划项目(编号:LHGJ20200459)。

摘　　要：目的 研究在小儿腹腔镜腹股沟疝手术麻醉过程中,使用膈肌超声指导喉罩拔除时机的可行性和安全性。方法 选取腹腔镜腹股沟疝修补手术患儿140例,随机将患儿分为膈肌超声指导拔除喉罩组(D组)和清醒拔除喉罩组(A组),两组患儿分别按照不同方式指导喉罩的拔除时机,比较两组患儿喉罩拔除过程中及拔除后出现咳嗽、拔除困难、喉痉挛、支气管痉挛、咽痛等呼吸不良事件的发生率,分析比较两组患儿外周血氧饱和度下降的发生率及处理方式。结果 D组患儿拔除困难和喉痉挛的发生率均低于A组患儿,差异有统计学意义(P<0.05),D组患儿发生呼吸不良事件的病例数少于A组患儿,差异有统计学意义(P<0.05)。D组患儿拔除喉罩后血氧饱和度下降的发生率低于A组患儿,差异有统计学意义(P<0.05)。D组患儿手术结束至拔除喉罩时间及Steward苏醒评分达4分时间均短于A组患儿,差异有统计学意义(P<0.05)。结论 在小儿腹腔镜腹股沟疝手术麻醉苏醒过程中,采用超声监测膈肌厚度变化率的方式可以更好地指导拔除喉罩,安全性更高。Objective To investigate the feasibility and safety of using diaphragmatic ultrasound to guide timing of laryngeal mask extraction during anaesthesia for laparoscopic inguinal hernia surgery in children.Methods A total of 140 children undergoing laparoscopic inguinal hernia repair surgery were selected,and the children were randomly divided into two groups:the group with laryngeal mask extraction guided by diaphragmatic ultrasound(Group D)and the group with laryngeal mask extraction guided by awake(group A).The two groups were instructed on the timing of laryngeal mask extraction according to different ways,and the incidence of adverse events,such as difficulty in pulling out,cough,laryngospasm,bronchospasm,and pharyngeal pain,were compared between the two groups during and after the extraction,the analysis compared the incidence and management of peripheral oxygen desaturation between the two groups.Results The rates of difficulty in pullout and laryngospasm in group D were both lower than those in group A,and the number of cases of adverse events in group D was lower than that in group A,the difference was statistically significant.The incidence of oxygen desaturation after removal of the laryngeal mask was lower in group D than in group A,and the difference was statistically significant.The time from the end of surgery to removal of the laryngeal mask and the steward awakening score up to 4 points in group D were shorter than those in group A,and the differences were statistically significant.Conclusion During awakening from anaesthesia for laparoscopic inguinal hernia surgery in children,monitoring the rate of change in diaphragmatic thickness with ultrasound can lead to better guidance in the extraction of laryngeal mask with a lower incidence of adverse effects and greater safety.

关 键 词：腹股沟疝 膈肌 超声 小儿 喉罩 

分 类 号：R614.2[医药卫生—麻醉学]