喉罩麻醉与气管插管麻醉在低龄先天性心脏病患儿介入封堵术中的应用比较  

Comparison of laryngeal mask airway anesthesia and endotracheal intubation anesthesia in interventional occlusion for young-age patients with congenital heart disease

作　　者：戴丹 刘婷婷 高静 胡瑶琴[1] DAI Dan;LIU Tingting;GAO Jing;HU Yaoqin(Department of Anesthesiology,Children′s Hospital Affiliated to School of Medicine of Zhejiang University,Hangzhou,Zhejiang,311200)

机构地区：[1]浙江大学医学院附属儿童医院麻醉科,浙江杭州311200

出　　处：《实用临床医药杂志》2024年第22期16-20,共5页Journal of Clinical Medicine in Practice

基　　金：国家自然科学基金项目(81901937)。

摘　　要：目的比较喉罩麻醉与气管插管麻醉在低龄先天性心脏病(简称先心病)患儿介入封堵术中的应用效果。方法选取102例接受介入封堵术治疗的低龄先心病患儿作为研究对象,采用随机数字表法分为对照组和观察组,每组51例。对照组实施气管插管麻醉,观察组实施喉罩下七氟烷全凭吸入麻醉。比较2组苏醒时间、拔管时间、喉痉挛发生率和肺部感染发生率,并比较2组不同时点血流动力学指标[心率(HR)、平均动脉压(MAP)]、氧化应激指标[丙二醛(MDA)、超氧化物歧化酶(SOD)]、心肌损伤指标[肌酸激酶同工酶(CK-MB)、心脏型脂肪酸结合蛋白(H-FABP)]水平。结果观察组苏醒时间、拔管时间短于对照组,肺部感染率、喉痉挛发生率低于对照组,差异有统计学意义(P<0.05)。麻醉前(T_(0)),2组患儿HR、MAP、MDA、SOD、CK-MB、H-FABP水平比较,差异无统计学意义(P>0.05);置入喉罩或插管时(T_(1))、动静脉穿刺时(T_(2))、置入封堵器即刻(T_(3)),观察组患儿HR、MAP、CK-MB、H-FABP水平均低于对照组,差异有统计学意义(P<0.05);T_(1)、T_(2)、T_(3)时点,2组患儿MDA水平均高于T_(0)时点,SOD水平均低于T_(0)时点,但观察组MDA水平低于对照组,SOD水平高于对照组,差异有统计学意义(P<0.05)。结论相较于气管插管麻醉,喉罩下七氟烷全凭吸入麻醉在低龄先心病患儿介入封堵术治疗中的应用效果更佳,能够有效维持术中血流动力学稳定,缩短苏醒时间和拔管时间,且安全性较高。Objective To compare the application effects of laryngeal mask airway anesthesia and endotracheal intubation anesthesia in interventional occlusion for young-age patients with congenital heart disease.Methods A total of 102 young-age patients with congenital heart disease undergoing interventional occlusion were enrolled and randomly divided into control group and observation group using a random number table method,with 51 patients in each group.The control group received endotracheal intubation anesthesia,while the observation group received sevoflurane anesthesia via laryngeal mask airway.The awakening time,extubation time,incidence of laryngeal spasm,and incidence of lung infection were compared between the two groups.Additionally,hemodynamic parameters[heart rate(HR),mean arterial pressure(MAP)],oxidative stress indicators[malondialdehyde(MDA),superoxide dismutase(SOD)],and myocardial injury indicators[creatine kinase-MB(CK-MB),heart-type fatty acid-binding protein(H-FABP)]levels at different time points were compared.Results The observation group had shorter awakening time and extubation time,and lower incidence of lung infection and laryngeal spasm compared with the control group(P<0.05).Before anesthesia(T_(0)),there were no statistically significant differences in HR,MAP,MDA,SOD,CK-MB,and H-FABP levels between the two groups(P>0.05).During laryngeal mask insertion or intubation(T_(1)),during arteriovenous puncture(T_(2)),and immediately after occluder placement(T_(3)),the observation group had lower HR,MAP,CK-MB,and H-FABP levels compared with the control group(P<0.05).At T_(1),T_(2),and T_(3),the MDA levels in both groups were higher than that at T_(0),and the SOD levels were lower than that at T_(0);however,the observation group had lower MDA levels and higher SOD levels compared with the control group(P<0.05).Conclusion Compared with endotracheal intubation anesthesia,sevoflurane anesthesia via laryngeal mask airway has a better application effect in interventional occlusion for young-age patients wit

关 键 词：喉罩 气管插管 先天性心脏病 低龄患儿 介入封堵术 血流动力学 肺部感染 喉痉挛 

分 类 号：R762.1[医药卫生—耳鼻咽喉科] R614.2[医药卫生—临床医学] R541.1