摘要
目的探讨可视软性喉镜定位双管喉罩通气在小儿腹腔镜疝囊高位结扎术中应用的安全性与可行性。方法行腹腔镜下小儿腹股沟疝疝囊高位结扎术患儿60例,按照随机数字表法分为气管导管插管组(ETT组)和喉罩通气道组(LMA组),每组30例。分别进行导管插管或双管喉罩维持术中通气。ETT组应用可视喉镜经口腔明视下完成气管导管插管,LMA组应用可视软性喉镜检查并定位喉罩栅栏与会厌、声门的位置关系。比较两组手术时间,二氧化碳气腹建立前(T_(0))、气腹建立后5 min(T_(1))、气腹建立后10 min(T_(2))、手术结束即刻(T_(3))的气道峰压(Ppeak),呼气末二氧化碳分压(P_(ET)CO_(2))围麻醉期情况。结果ETT组手术时间(25.0±5.4)min,与LMA组的(24.8±5.8)min比较,差异无统计学意义(P>0.05)。ETT组T_(0)、T_(1)、T_(2)、T_(3)的Ppeak分别为(13.53±1.50)、(14.20±1.40)、(14.87±1.65)、(14.70±1.69)cm H_(2)O(1 cm H_(2)O=0.098 kPa),P_(ET)CO_(2)分别为(37.50±1.83)、(39.97±2.27)、(40.80±2.68)、(37.70±2.15)mm Hg(1 mm Hg=0.133 kPa),LMA组T_(0)、T_(1)、T_(2)、T_(3)的Ppeak分别为(13.27±1.55)、(14.40±1.07)、(15.40±1.25)、(14.90±1.26)cm H_(2)O,P_(ET)CO_(2)分别为(36.57±1.81)、(39.51±1.78)、(40.70±1.93)、(38.57±2.27)mm Hg。两组在T_(1)、T_(2)时的Ppeak、P_(ET)CO_(2)较T_(0)的逐渐升高,在T_(3)时均恢复至正常水平,但两组T_(0)、T_(1)、T_(2)、T_(3)的Ppeak、P_(ET)CO_(2)比较,差异无统计学意义(P>0.05)。ETT组气管导管插管或喉罩置入一次成功率93.3%(28/30)与LMA组的90.0%(27/30)比较,差异无统计学意义(P>0.05)。LMA组术后24 h咽痛或吞咽痛发生率3.3%(1/30)低于ETT组的20.0%(6/30),气管导管拔管或喉罩拔除时间(5.13±1.25)min短于ETT组的(8.83±1.58)min(P<0.05)。两组低氧血症、喉痉挛、反流与误吸、套囊或通气罩带血发生率比较,差异无统计学意义(P>0.05)。结论可视软性喉镜有助于判断并调整小儿喉罩位置,可安全应用于小儿腹腔镜疝囊高位结扎术中。
Objective To explore the safety and feasibility of flexible video laryngoscope positioning laryngeal mask airway in laparoscopic high ligation of hernia sac in children.Methods According to random numerical table,60 child patients undergoing laparoscopic high ligation of hernia sac of inguinal hernia were allocated to endotracheal tube group(ETT group)and laryngeal mask airway group(LMA group),each consisting of 30 patients.Endotracheal intubation or double-tube laryngeal mask were used to maintain intraoperative ventilation.In ETT group,tracheal intubation was completed under video laryngoscope.In LMA group,flexible video laryngoscope was used to check the correlation between the position of laryngeal mask palisade and epiglottis,glottis.Comparison of surgical time,peak airway pressures(Ppeak)and partial pressure of end-tidal carbon dioxide(P_(ET)CO_(2))before the establishment of carbon dioxide pneumoperitoneum(T_(0)),5 minutes after the establishment of pneumoperitoneum(T_(1)),10 minutes after the establishment of pneumoperitoneum(T_(2)),and immediately after the end of surgery(T_(3)),peri-anesthesia conditions between the two groups.Results The surgical time of ETT group was(25.0±5.4)min,and there was no statistically significant difference compared to the LMA group's(24.8±5.8)min(P>0.05).In ETT group,the Ppeak at T_(0),T_(1),T_(2),and T_(3) were(13.53±1.50),(14.20±1.40),(14.87±1.65),and(14.70±1.69)cm H_(2)O(1 cm H_(2)O=0.098 kPa),and the P_(ET)CO_(2) were(37.50±1.83),(39.97±2.27),(40.80±2.68),and(37.70±2.15)mm Hg(1 mm Hg=0.133 kPa);in LMA group,the Ppeak at T_(0),T_(1),T_(2),and T_(3) were(13.27±1.55),(14.40±1.07),(15.40±1.25),and(14.90±1.26)cm H_(2)O,and the P_(ET)CO_(2) were(36.57±1.81),(39.51±1.78),(40.70±1.93),and(38.57±2.27)mm Hg.The Ppeak and P_(ET)CO_(2) of the two groups of children gradually increased at T_(1) and T_(2) compared with those at T_(0),and both returned to the normal level at T_(3).However,there was no statistically significant difference in Ppeak and P_(ET)CO_(2) between the two groups of patients at T_(0),T_(1),T_(2),and T_(3)(P>0.05).The one-time success rate of endotracheal tube intubation or laryngeal mask placement in ETT group was 93.3%(28/30),and the difference was not statistically significant when compared with 90.0%(27/30)in LMA group(P>0.05).The incidence of sore throat or swallowing pain in LMA group was 3.3%(1/30),which was lower than 20.0%(6/30)in ETT group;the time to endo tracheal tube or laryngeal mask(5.13±1.25)min was shorter than(8.83±1.58)min in ETT group;there was a statistically significant difference(P<0.05).There was no statistically significant difference in comparison of incidence rates of hypoxemia,laryngeal spasm,reflux and aspiration and bloody cuff or airway mask between the two groups(P>0.05).Conclusion Flexible video laryngoscope is helpful to judge and adjust the position of laryngeal mask airway in children,and can be safely used in laparoscopic high ligation of hernia sac in children.
作者
岳冬梅
裴玉平
张钰
YUE Dong-mei;PEI Yu-ping;ZHANG Yu(Department of Anesthesiology,Affiliated Hospital of Xuzhou Medical University,Xuzhou 221002,China)
出处
《中国实用医药》
2025年第16期61-64,共4页
China Practical Medicine
关键词
可视软性喉镜
喉罩
腹腔镜
小儿腹股沟疝疝囊高位结扎术
麻醉
气管导管插管
Flexible video laryngoscope
Laryngeal mask
Laparoscope
High ligation of hernia sac of inguinal hernia in children
Anesthesia
Endotracheal tube
