Proseal喉罩在小儿腹腔镜下疝囊高位结扎术中应用的安全性与可行性分析
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摘要
目的:研究Proseal喉罩在小儿腹腔镜下疝囊高位结扎术中应用的安全性和可行性。方法:选择本院在2016年8月-2017年8月收治的80例行腹腔镜疝囊高位结扎手术患儿为观察对象,根据不同的通气方式将患儿分为对照组和观察组,每组40例。对照组患儿使用气管插管通气,观察组患儿使用Proseal喉罩通气。记录两组患儿第一次置入成功的比例,两组患儿的麻醉诱导前(T1)、置入喉罩或者气管导管即刻(T2)、置入后3 min(T3)、拔出喉罩或者气管导管即刻(T4)及拔出喉罩或者气管导管3 min(T5)时的心率(HR)、脉搏氧饱和度(SpO_2)及血压(MAP),并记录潮气量在10 mL/kg时置入后3 min、间歇正压通气10 min和气腹后10 min的气道平台压(Pplat)、二氧化碳分压(P_(ET)CO_2)及气道峰压(Ppeak)。对比两组患儿在手术过程中及手术后出现误吸、反流、喉水肿、呛咳及声音嘶哑等并发症的发生情况。结果:两组患儿第一次置入成功率比较,差异无统计学意义(P>0.05)。两组T1、T5的HR比较,差异均无统计学意义(P>0.05);对照组T2、T3、T4的HR均快于观察组,差异均有统计学意义(P<0.05)。观察组各时间点的MAP均高于对照组,差异均有统计学意义(P<0.05),尤其是T2、T4的MAP显著高于对照组。两组各时间点的SpO_2比较,差异均无统计学意义(P>0.05)。观察组患儿的苏醒时间短于对照组,差异有统计学意义(P<0.05)。与气腹前比较,两组患儿气腹后10 min的Pplat、Ppeak及P_(ET)CO_2均明显升高,差异均有统计学意义(P<0.05)。两组各时间点Pplat、Ppeak及P_(ET)CO_2比较,差异均有统计学意义(P<0.05)。两组患儿在手术过程中均未出现误吸及反流的现象,在手术后,观察组患儿的其他不良反应发生率均低于对照组,差异均有统计学意义(P<0.05)。结论:Proseal喉罩在小儿腹腔镜下疝囊高危结扎术后使用具有较高的安全性,并且操作简单,具有较高的成功率,并发症发生率较低,值得临床推广使用。
Objective:To study the safety and feasibility of Proseal laryngeal mask in laparoscopic high ligation of hernia sac.Method:80 children underwent laparoscopic hernia sac high ligation in our hospital from August 2016 to August 2017 were selected as observation objects,according to the different way of ventilation,they were divided into the control group and observation group,40 cases in each group.The ratio of successful placement for the first time in the two groups was recorded,HR,SpO_2 and MAP of the two groups were recorded before induction of anesthesia(T1),immediate placement of laryngeal mask or trachea catheter(T2),3 min after implantation(T3),pulling out the laryngeal mask or tracheal catheter immediately(T4)and pull out larynx mask or trachea tube 3 min(T5),the tidal volume was recorded in 10 m L/kg,Pplat,carbon dioxide partial pressure(P_(ET)CO_2)and Ppeak at 3 min after implantation,10 min in intermittent positive pressure ventilation and 10 min after pneumoperitoneum.The incidence of complications such as aspiration,reflux,laryngeal edema,cough and hoarholism were observed during operation and after operation in two groups.Result:There was no significant difference in the success rate of the first implantation between the two groups(P>0.05).There were no significant differencea in HR between the two groups at T1 and T5(P>0.05);the HR of the control group at T2,T3 and T4 were faster than those of the observation group,the differences were statistically significant(P<0.05).The MAP of the observation group were higher than those of the control group at each time point,the differences were statistically significant(P<0.05),especially the MAP of T2 and T4 were significantly higher than those of the control group.There were no significant differences in the difference of SpO_2 between the two groups at each time point(P>0.05).The recovery time of the patients in the observation group was shorter than that in the control group(P<0.05).Compared with the pre-insufflation,the Pplat,Ppeak and P_(ET)CO_2 of the two groups were significantly higher,the differences were statistically significant(P<0.05).There were significant differences between the two groups at different time points in Pplat,Ppeak and P_(ET)CO_2(P<0.05).No missuction and regurgitation occurred in the two groups during the operation,after operation,the incidence of other adverse reactions in the observation group were lower than those in the control group,the differences were statistically significant(P<0.05).Conclusion:Proseal larynx mask has high safety,simple operation,high success rate and low incidence of complications after laparoscopic high risk ligation of hernia sac in children,so it is worth popularizing in clinic.
Objective:To study the safety and feasibility of Proseal laryngeal mask in laparoscopic high ligation of hernia sac.Method:80 children underwent laparoscopic hernia sac high ligation in our hospital from August 2016 to August 2017 were selected as observation objects,according to the different way of ventilation,they were divided into the control group and observation group,40 cases in each group.The ratio of successful placement for the first time in the two groups was recorded,HR,SpO_2 and MAP of the two groups were recorded before induction of anesthesia(T1),immediate placement of laryngeal mask or trachea catheter(T2),3 min after implantation(T3),pulling out the laryngeal mask or tracheal catheter immediately(T4)and pull out larynx mask or trachea tube 3 min(T5),the tidal volume was recorded in 10 m L/kg,Pplat,carbon dioxide partial pressure(P_(ET)CO_2)and Ppeak at 3 min after implantation,10 min in intermittent positive pressure ventilation and 10 min after pneumoperitoneum.The incidence of complications such as aspiration,reflux,laryngeal edema,cough and hoarholism were observed during operation and after operation in two groups.Result:There was no significant difference in the success rate of the first implantation between the two groups(P>0.05).There were no significant differencea in HR between the two groups at T1 and T5(P>0.05);the HR of the control group at T2,T3 and T4 were faster than those of the observation group,the differences were statistically significant(P<0.05).The MAP of the observation group were higher than those of the control group at each time point,the differences were statistically significant(P<0.05),especially the MAP of T2 and T4 were significantly higher than those of the control group.There were no significant differences in the difference of SpO_2 between the two groups at each time point(P>0.05).The recovery time of the patients in the observation group was shorter than that in the control group(P<0.05).Compared with the pre-insufflation,the Pplat,Ppeak and P_(ET)CO_2 of the two groups were significantly higher,the differences were statistically significant(P<0.05).There were significant differences between the two groups at different time points in Pplat,Ppeak and P_(ET)CO_2(P<0.05).No missuction and regurgitation occurred in the two groups during the operation,after operation,the incidence of other adverse reactions in the observation group were lower than those in the control group,the differences were statistically significant(P<0.05).Conclusion:Proseal larynx mask has high safety,simple operation,high success rate and low incidence of complications after laparoscopic high risk ligation of hernia sac in children,so it is worth popularizing in clinic.
引文
[1]王凤群,何荣,郝其勇,等.免充气喉罩在小儿腹腔镜疝囊高位结扎手术中的应用观察[J/OL].世界最新医学信息文摘:电子版,2016,16(93):9-10.
[2]胡玲,王瑞婷,潘建辉,等.一次性双管喉罩在小儿腹腔镜下疝囊高位结扎手术中的应用[J].广东医学,2015,36(15):2379-2381.
[3]谭健,朱红妞.骶管阻滞复合基础麻醉在小儿腹腔镜疝气手术中的应用研究[J].中国医学创新,2012,9(16):43-44.
[4]康路,李查兵.双管喉罩在小儿腹部手术中的应用[J].医学信息,2014,27(3):65-66.
[5]胡宗举,宁长青,孙雪峰,等.改良疝针在腹腔镜下小儿疝高位结扎术的应用体会[J].中华全科医学,2017,15(7):1156-1158.
[6]杨梦晨.喉罩通气在小儿腹腔镜疝囊高位结扎术中的应用[J].医学信息,2011,24(8):5370-5371.
[7]李瑜.双管喉罩在小儿腹腔镜手术中的应用[J].首都食品与医药,2015(20):29.
[8]金进宇,赵文城,彭峻松.双管喉罩在妇科腹腔镜手术中应用的临床研究[J].河北医学,2014,20(2):244-246.
[9]胡玲,康路,王瑞婷,等.I-gel喉罩与Supreme喉罩在小儿腹腔镜手术中的应用比较[J].实用医学杂志,2016,32(13):2245-2246.
[10]夏杰,陈功波,陈功华.小儿腹腔镜疝内口关闭与开放疝囊高位结扎术的临床比较研究[J].中国医药指南,2013,11(13):435-436.
[11]李延辉.腹腔镜下疝囊高位结扎日间手术治疗小儿腹股沟疝的疗效[J].实用临床医学,2013,14(4):51-52.
[12]陈依君,张珏,谢颖,等.双管喉罩在小儿麻醉中的应用[J].临床麻醉学杂志,2012,28(1):22-24.
[13]郭璐娣,杜思甜,赵佩君,等.喉罩全麻加骶管阻滞麻下行小儿腹腔镜疝囊高位结扎术的效果观察与护理[J].护理实践与研究,2017,14(6):71-72.
[14]姜宏志,张启龙,刘强.套管内推结法及常规穿刺结扎法在腹腔镜小儿疝囊高位结扎术中的对比研究[J].中华小儿外科杂志,2017,38(9).
[15]袁以好,刘正霞,吴战荣,等.一次性双管喉罩在临床麻醉中的应用[J].安徽卫生职业技术学院学报,2011,10(2):21-23.
[16]黄时富.骶管阻滞复合七氟烷吸入用于腹腔镜下小儿斜疝疝囊高位结扎术[J].中国伤残医学,2013,21(12):112-113.
[17]杨梦晨.婴幼儿腹腔镜疝囊高位结扎术中喉罩与气管插管的临床应用比较[J].中国临床实用医学,2014,8(3):47-49.
[18]汪志勇,王向东,涂远艳.Pro Seal喉罩在小儿腹腔镜下疝囊高位结扎术中应用[J].黑龙江医药,2017,30(3):510-513.
[2]胡玲,王瑞婷,潘建辉,等.一次性双管喉罩在小儿腹腔镜下疝囊高位结扎手术中的应用[J].广东医学,2015,36(15):2379-2381.
[3]谭健,朱红妞.骶管阻滞复合基础麻醉在小儿腹腔镜疝气手术中的应用研究[J].中国医学创新,2012,9(16):43-44.
[4]康路,李查兵.双管喉罩在小儿腹部手术中的应用[J].医学信息,2014,27(3):65-66.
[5]胡宗举,宁长青,孙雪峰,等.改良疝针在腹腔镜下小儿疝高位结扎术的应用体会[J].中华全科医学,2017,15(7):1156-1158.
[6]杨梦晨.喉罩通气在小儿腹腔镜疝囊高位结扎术中的应用[J].医学信息,2011,24(8):5370-5371.
[7]李瑜.双管喉罩在小儿腹腔镜手术中的应用[J].首都食品与医药,2015(20):29.
[8]金进宇,赵文城,彭峻松.双管喉罩在妇科腹腔镜手术中应用的临床研究[J].河北医学,2014,20(2):244-246.
[9]胡玲,康路,王瑞婷,等.I-gel喉罩与Supreme喉罩在小儿腹腔镜手术中的应用比较[J].实用医学杂志,2016,32(13):2245-2246.
[10]夏杰,陈功波,陈功华.小儿腹腔镜疝内口关闭与开放疝囊高位结扎术的临床比较研究[J].中国医药指南,2013,11(13):435-436.
[11]李延辉.腹腔镜下疝囊高位结扎日间手术治疗小儿腹股沟疝的疗效[J].实用临床医学,2013,14(4):51-52.
[12]陈依君,张珏,谢颖,等.双管喉罩在小儿麻醉中的应用[J].临床麻醉学杂志,2012,28(1):22-24.
[13]郭璐娣,杜思甜,赵佩君,等.喉罩全麻加骶管阻滞麻下行小儿腹腔镜疝囊高位结扎术的效果观察与护理[J].护理实践与研究,2017,14(6):71-72.
[14]姜宏志,张启龙,刘强.套管内推结法及常规穿刺结扎法在腹腔镜小儿疝囊高位结扎术中的对比研究[J].中华小儿外科杂志,2017,38(9).
[15]袁以好,刘正霞,吴战荣,等.一次性双管喉罩在临床麻醉中的应用[J].安徽卫生职业技术学院学报,2011,10(2):21-23.
[16]黄时富.骶管阻滞复合七氟烷吸入用于腹腔镜下小儿斜疝疝囊高位结扎术[J].中国伤残医学,2013,21(12):112-113.
[17]杨梦晨.婴幼儿腹腔镜疝囊高位结扎术中喉罩与气管插管的临床应用比较[J].中国临床实用医学,2014,8(3):47-49.
[18]汪志勇,王向东,涂远艳.Pro Seal喉罩在小儿腹腔镜下疝囊高位结扎术中应用[J].黑龙江医药,2017,30(3):510-513.