喉罩与气管导管在小儿手术中的应用
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摘要
本文旨在明确全身麻醉下择期小儿手术中应用喉罩和气管导管两种气道管理设备血流动力学变化及临床应用的研究。为选择喉罩应用于小儿全身麻醉气道管理提供进一步参考。本研究选择拟全身麻醉下,行择期的小儿手术的病人40例,年龄4~7岁,体重10~30kg。随机分成A、B两组,A组为喉罩组,B组为气管导管组,每组各20例。两组均给予相同的麻醉方法及药物,术中常规应用麻醉性镇痛药和肌肉松弛药。麻醉医生根据自身经验和手术需要调控麻醉深度。常规监测收缩压(SBP)﹑舒张压(DBP)﹑平均动脉压(MAP)、心率(HR)﹑血氧饱和度(SPO2),呼气末二氧化碳分压(PETCO2)建立静脉通路。麻醉诱导:面罩吸氧5L/min加8%七氟醚3min,咪达唑仑0.05mg/kg,芬太尼2~4μg/kg。麻醉维持:七氟醚1.5%,术中根据情况间断给予麻醉性镇痛和肌肉松弛药物。麻醉过程中不在使用咪达唑仑。监测:诱导前(T0)、诱导后(T1)、喉罩或气管插管置入即刻(T2)、插管后3min(T3)、拔管前3min(T4)、拔管时(T5)、拔管后(T6)七个时间点的SBP﹑DBP﹑MAP、HR﹑SPO2、及PETCO2,同时观察首次置管的成功率和插拔管时是否有呛咳屏气、体动、分泌物过多、喉痉挛、管带血、反流误吸。并在术后2h、术后8h及术后12h随访,观察病人是否会出现声音嘶哑和咽喉红肿。使用SPSS13.0软件进行统计分析。评价两种气道管理设备应用时,血流动力学变化及临床应用的安全性。结果提示:本研究表明,小儿择期手术全身麻醉应用喉罩通气相对气管导管能够在一定程度上血流动力学影响小,并能减少对呼吸道刺激,术后不良反应少,利于术后顺利恢复,能够增加患者的舒适度。在儿科全身麻醉患者应用喉罩优于气管导管。
This paper aims to study hemodynamic changes and clinical application about the security of two kinds of airway management methods which are trachea pipe and laryngeal mask under general anesthesia in elective pediatric abdominal surgery.
Objective: The aim of this study is to observe the hemodynamic changes of two kinds of airway management methds, trachea pipe and laryngeal mask .then to offer more reliable evidence for choosing laryngeal mask under general anesthesia in the pediatric colorectal surgery.
Methods: 40 cases of pediatric patients under selective abdominal surgery were choosen to study. ASA: I - II, were randomized into A and B group.group A is laryngeal mask group (n=20) and group B is endotracheal tube group (n=20). 40 Patients (3-8 years) scheduled to undergo selective colorectal surgery, weight 10-30kg. Before operation, patients have no throat sore, no tracheal obstruction, no apparent abnormality in psychology and nerve, no antiadoncus, no loosening of teeth, no esophageal reflux, no laryngeal softening history, and no respiratory infections in Nearly two weeks. The surgical time is about 1 hour and the study has been acquired the consent of patients’relatives. Surgery include resection of hemangioma of abdominal wall, appendectomy, orchidopexy, and fold inguen herniorrhaphy, and so on. All patients forbidden drink and diet for 4-6h. And patients will be injected intramuscularly 0.02 mg/kg of atropine and will take 0.5-0.75mg/kg midazolam by mouth in 30min before operation. After patinents entered into operation room, oxygen uptake, open vein injection and link monitor. The method of anesthesia and drugs are identical in two groups. anesthesia induction: inspired oxygen by mask 5L/min and sevoflurane, 8% for 3 minutes, Midazolam 0.05 mg/kg, fentanyl 2~4μg/kg. anesthesia maintain: 1.5% sevoflurane,then according to the situation, given anesthesia analgesia and muscle relaxation drugs interruptedly. Anesthesia depth will reach to: no reflexes of eyelids and loose of submaxilla. According to the age and weight of patients, proper laryngeal mask and tracheal intubation were given. The tube establishiment of all patients will be operated by the same doctor.
Monitor: there are seven time point: before induction (T0), after induction (T1), after laryngeal mask or tracheal intubation immediately (T2), after intubation 3 min (T3), 3min before extubation (T4) ,extubation (T5), after extubation (T6), observe MAP, DBP SBP, HR, SPO2 and PETCO2 at every time point, and observe the rate of the first tracheal intubation and whether exsit bucking, breathholding , body movement, cough, laryngospasm, contraflow, aspiration in the time of extubation.
Results: the alteration of hemodynamics: there is no obviously difference of MAP and HR between T0 and T1 time point (P>0.05). Between T2 and T3 time point, there is significant difference of MAP and HR (P<0.05). And there is significant difference of MAP and HR between every group at T5 time point (P<0.05).
Side effect: there are no movement of body in the two group when inserted catheter tube; when extubate catheter tube, there is one patient have body movement, one patient have breathholding in group A; however, in group B, there are two patient have bucking, one patient have laryngospasm ,four patient have body movement and one patient with blood in tube. The achievement ratio of inserted tube is 98% in the two groups.
This research showed that, compared with endotracheal tube, application of laryngeal mask airway under general anesthesia in pediatric selective colorectal surgery can alleviate hemodynamics, and facilitate postoperative recovery via attenuating stimulation of respiratory tract. laryngeal mask is better than endotracheal tube in the pediatric general anesthesia.
This paper aims to study hemodynamic changes and clinical application about the security of two kinds of airway management methods which are trachea pipe and laryngeal mask under general anesthesia in elective pediatric abdominal surgery.
Objective: The aim of this study is to observe the hemodynamic changes of two kinds of airway management methds, trachea pipe and laryngeal mask .then to offer more reliable evidence for choosing laryngeal mask under general anesthesia in the pediatric colorectal surgery.
Methods: 40 cases of pediatric patients under selective abdominal surgery were choosen to study. ASA: I - II, were randomized into A and B group.group A is laryngeal mask group (n=20) and group B is endotracheal tube group (n=20). 40 Patients (3-8 years) scheduled to undergo selective colorectal surgery, weight 10-30kg. Before operation, patients have no throat sore, no tracheal obstruction, no apparent abnormality in psychology and nerve, no antiadoncus, no loosening of teeth, no esophageal reflux, no laryngeal softening history, and no respiratory infections in Nearly two weeks. The surgical time is about 1 hour and the study has been acquired the consent of patients’relatives. Surgery include resection of hemangioma of abdominal wall, appendectomy, orchidopexy, and fold inguen herniorrhaphy, and so on. All patients forbidden drink and diet for 4-6h. And patients will be injected intramuscularly 0.02 mg/kg of atropine and will take 0.5-0.75mg/kg midazolam by mouth in 30min before operation. After patinents entered into operation room, oxygen uptake, open vein injection and link monitor. The method of anesthesia and drugs are identical in two groups. anesthesia induction: inspired oxygen by mask 5L/min and sevoflurane, 8% for 3 minutes, Midazolam 0.05 mg/kg, fentanyl 2~4μg/kg. anesthesia maintain: 1.5% sevoflurane,then according to the situation, given anesthesia analgesia and muscle relaxation drugs interruptedly. Anesthesia depth will reach to: no reflexes of eyelids and loose of submaxilla. According to the age and weight of patients, proper laryngeal mask and tracheal intubation were given. The tube establishiment of all patients will be operated by the same doctor.
Monitor: there are seven time point: before induction (T0), after induction (T1), after laryngeal mask or tracheal intubation immediately (T2), after intubation 3 min (T3), 3min before extubation (T4) ,extubation (T5), after extubation (T6), observe MAP, DBP SBP, HR, SPO2 and PETCO2 at every time point, and observe the rate of the first tracheal intubation and whether exsit bucking, breathholding , body movement, cough, laryngospasm, contraflow, aspiration in the time of extubation.
Results: the alteration of hemodynamics: there is no obviously difference of MAP and HR between T0 and T1 time point (P>0.05). Between T2 and T3 time point, there is significant difference of MAP and HR (P<0.05). And there is significant difference of MAP and HR between every group at T5 time point (P<0.05).
Side effect: there are no movement of body in the two group when inserted catheter tube; when extubate catheter tube, there is one patient have body movement, one patient have breathholding in group A; however, in group B, there are two patient have bucking, one patient have laryngospasm ,four patient have body movement and one patient with blood in tube. The achievement ratio of inserted tube is 98% in the two groups.
This research showed that, compared with endotracheal tube, application of laryngeal mask airway under general anesthesia in pediatric selective colorectal surgery can alleviate hemodynamics, and facilitate postoperative recovery via attenuating stimulation of respiratory tract. laryngeal mask is better than endotracheal tube in the pediatric general anesthesia.
引文
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