不同PEEP对腹腔镜手术患儿喉罩通气效果的影响:超声评估  

Influence of different positive end-expiratory pressure on ventilation of laryngeal mask airway in pediatric patients undergoing laparoscopic surgery:an ultrasound assessment

作　　者：魏晶晶 陈耀 郭芳[2] 王存金[2] 高巨[2] Wei Jingjing;Chen Yao;Guo Fang;Wang Cunjin;Gao Ju(Department of Anesthesiology,Northern Jiangsu People′s Hospital Affiliated to Yangzhou University,Yangzhou 225001,China;Department of Anesthesiology,Northern Jiangsu People′s Hospital,Yangzhou,225001,China)

机构地区：[1]扬州大学附属苏北人民医院麻醉科,扬州225001 [2]江苏省苏北人民医院麻醉科,扬州225001

出　　处：《中华麻醉学杂志》2025年第2期184-188,共5页Chinese Journal of Anesthesiology

基　　金：国家自然科学基金面上项目(82171207);江苏省自然科学基金面上项目(BK20231246);江苏省科协青年科技人才支持项目(2021-008);江苏省"333"高层次人才培养工程优秀青年人才(2022-3-6-146)。

摘　　要：目的采用超声评估法评价不同呼吸末正压(PEEP)对腹腔镜手术患儿喉罩通气效果的影响。方法本研究为随机对照试验。择期行腹腔镜手术患儿90例, 年龄2~10岁, 性别不限, ASA分级Ⅰ或Ⅱ级, BMI 12~22 kg/m^(2), 采用随机数字表法分为3组(n=30):P0组、P3组和P5组。采取压力控制模式, 吸呼比1∶2, 流量2 L/min、RR 16~26次/min。P0组、P3组和P5组PEEP分别0、3和5 cmH_(2)O(1 cmH_(2)O=0.098 kPa)。于气腹后每5 min记录喉罩超声评分和错位率, 记录患儿术中低氧血症(SpO_(2)<92%)和P_(ET)CO_(2)≥45 mmHg(1 mmHg=0.133 kPa)的发生情况, 记录喉罩拔除后低氧血症、喉罩带血和声音嘶哑的发生情况。结果与P0组比较, P3组气腹15 min时超声评分升高, P5组超声评分和喉罩错位率升高, 其他指标差异无统计学意义(P>0.05);与P3组比较, P5组各指标差异均无统计学意义(P>0.05)。3组术后并发症发生率比较差异无统计学意义(P>0.05)。结论 PEEP 3 cmH_(2)O时腹腔镜手术患儿喉罩通气效果较好。Objective To evaluate the influence of different positive end-expiratory pressure on the ventilation of laryngeal mask airway in pediatric patients undergoing laparoscopic surgery through ultrasound assessment.MethodsIn this randomized controlled trial,90 pediatric patients of both sexes,of American Society of Anesthesiologists Physical Status classificationⅠorⅡ,aged 2-10 yr,with a body mass index of 12-22 kg/m^(2),scheduled for elective laparoscopic surgery,were divided into 3 groups(n=30 each)by a random number table method:group P0,group P3,and group P5.Each group adopted the pressure-controlled mode with an inspiration/expiration ratio of 1∶2,a flow rate of 2 L/min,and a respiratory rate of 16-26 breaths/min.The positive end-expiratory pressure was set at 0,3 and 5 cmH 2O(1 cmH_(2)O=0.098 kPa)in P0,P3 and P5 groups respectively.The ultrasonic scores and misalignment rate of the laryngeal mask airway were recorded every 5 min following the pneumoperitoneum,and the occurrence of intraoperative hypoxemia(SpO_(2)<92%)and P ETCO_(2)≥45 mmHg(1 mmHg=0.133 kPa)was recorded.The development of hypoxemia,blood staining on the laryngeal mask airway and hoarseness after laryngeal mask airway removal were also recorded.ResultsCompared with P0 group,the ultrasound scores were significantly increased at 15 min of pneumoperitoneum in P3 group(P<0.05),and the ultrasound scores and the laryngeal mask airway misplacement rate were significantly increased,and no significant change was found in the other parameters in P5 group(P<0.05).There were no statistically significant differences in each parameter between P5 group and P3 group(P>0.05).There was no statistically significant difference in the incidence of postoperative complications among the three groups(P>0.05).ConclusionsThe laryngeal mask airway provides better ventilatory effect in pediatric patients undergoing laparoscopic surgery when the PEEP is set at 3 cmH_(2)O.

关 键 词：喉面罩 正压呼吸 超声 

分 类 号：R726.1[医药卫生—儿科] R614[医药卫生—临床医学]