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目的评价可弯曲喉罩用于小儿扁桃体摘除术患者的安全性和有效性。方法择期行扁桃体摘除术患儿30例,年龄2~10岁,体质量10~50 kg,ASA分级Ⅰ~Ⅱ级,采用随机数字表法均分成两组:喉罩组和气管插管组,每组15例。麻醉诱导:喉罩组使用咪达唑仑0.1 mg/kg、丙泊酚3 mg/kg、舒芬太尼0.5μg/kg,气管插管组加用顺式阿曲库铵0.15 mg/kg。麻醉维持:两组均使用丙泊酚6~10 mg/(kg·h)、瑞芬太尼0.2~0.5μg/(kg·min)静脉泵注。记录麻醉诱导前(T_0)、麻醉诱导后(T_1)、置入喉罩或气管导管即刻(T_2)、置入开口器及手术开始即刻(T_3)、手术结束时(T_4)和拔除喉罩或气管导管即刻(T_5)的心率(heart rate,HR)、平均动脉血压(mean arterial pressure,MAP),并于T_0、T_2、T_3、T_5采集血样测量血糖和皮质醇浓度;记录麻醉药物用量、液体出入量、麻醉时间、自主呼吸恢复时间、拔管时间、麻醉苏醒时间;并记录置入喉罩或气管插管的首次成功率和总成功率、麻醉恢复期间并发症(躁动、胃胀气、呛咳、喉痉挛等)发生情况。结果与气管插管组比较,喉罩组患儿自主呼吸恢复时间、拔除喉罩时间、苏醒时间明显缩短(P<0.05);与T_1比较,气管插管组T_2的HR、MAP明显升高(P<0.05),而喉罩组差异无统计学意义,气管插管组T_2、T_5时刻的HR、MAP明显高于喉罩组(P<0.05);喉罩组术后呛咳发生率明显降低(P<0.05)。结论可弯曲喉罩用于小儿扁桃体摘除术应激反应小,并发症少,安全有效,值得在临床推广应用。
Objective To evaluate the safety and efficacy of a flexible laryngeal mask for pediatric tonsillectomy. Methods Thirty patients (aged 2 to 10 years old, body weight 10 ~ 50 kg and ASA grade Ⅰ ~ Ⅱ) undergoing elective tonsillectomy were randomly divided into two groups: laryngeal mask group and tracheal intubation group, 15 cases in each group. Induction of anesthesia: Midazolam 0.1 mg / kg, propofol 3 mg / kg and sufentanil 0.5 μg / kg were used in the laryngeal mask group, and cisatracurium 0.15 mg / kg was given to the intubation group. Anesthesia maintenance: Both groups were given intravenous infusion of propofol 6 ~ 10 mg / (kg · h) and remifentanil 0.2 ~ 0.5 μg / (kg · min). (T_0), anesthesia induction (T_1), laryngeal mask or endotracheal tube immediately (T_2), placement of opener and immediate start of operation (T_3), at the end of operation The heart rate (HR) and mean arterial pressure (MAP) of the tracheal tube were measured at the same time. The blood glucose and cortisol concentrations were measured at T_0, T_2, T_3 and T_5. The amount of anesthetic drug, Anesthesia time, spontaneous breathing recovery time, extubation time, anesthesia wake time; and recorded the first success rate and assembly success rate into the laryngeal mask or endotracheal intubation, complications during anesthesia recovery (restlessness, flatulence, choke Cough, laryngospasm, etc.) occurred. Results Compared with endotracheal intubation group, the recovery time of spontaneous breathing, the time of removing laryngeal mask and the recovery time of children with laryngeal mask and laryngeal mask were significantly shortened (P <0.05). Compared with T_1, the HR and MAP of T_2 in tracheal intubation group were significantly increased P <0.05), while there was no significant difference in laryngeal mask group (P> 0.05). The HR and MAP of T 2 and T 5 in tracheal intubation group were significantly higher than those in laryngeal mask group (P <0.05) (P <0.05). Conclusion Flexible laryngeal mask for pediatric tonsillectomy stress response, fewer complications, safe and effective, it is worth in the clinical application.