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目的在靶控输注瑞芬太尼、丙泊酚静脉麻醉下,比较双管喉罩(PLMA)与普通气管导管(TT)用于小儿斜视矫正术中机械肺通气的可行性。方法选择行择期小儿斜视矫正术患儿120例,年龄3-13岁,随机分为两组:PLMA组(n=60),TT组(n=60),在靶控输注瑞芬太尼和丙泊酚静脉麻醉下插入PLAM或TT。诱导插管时观察两组患儿肢动、咳嗽、挣扎及插管次数,在诱导前、诱导后、插管即刻、牵拉眼肌及拔管后5min记录HR、MAP及SPO2。在插管即刻、手术10min及牵拉眼肌时记录Ppeak及PETCO2。手术开始10min两组患儿各20例从挠动脉取血,检测血气。拔管后即刻记录瑞芬太尼和丙泊酚效应部位浓度及药物总量,观察困难拔管及拔管后24小时恶心、呕吐、躁动、过度镇静、咳嗽、喉痉挛、舌后坠、咽部不适等不良反应。结果两组患儿在年龄、性别、身高、体重、手术、麻醉及苏醒时间比较无统计学差异(P>0.05)。PLAM组在各时间点的HR与TT组比较无统计学差异(P>0.05),术中两组患儿均出现不同程度的眼心反射,其中HR低于60次/min,PLMA组28例,TT组27例,两组各有2例HR明显减慢至22～30次/min。两组Ppeak及PETCO2在术中未见明显升高,无统计学差异(P>0.05)。术中血气分析(n=20)PaCO2显示,PLMA为44.4±3.1mmHg,TT组为43.9±2.7mmHg,两组比较无统计学差异(P>0.05)。诱导时出现呛咳PLMA组22例,TT组18例。拔管时PLMA组出现1例从食管通道胃液返流。结论PLMA操作简便,患儿插入与拔出时咽喉部刺激性小,诱导及麻醉过程中血液动力学平稳,密封性好,通气可靠,适用于小儿斜视手术的麻醉。
Objective To compare the feasibility of mechanically ventilated laparoscopic surgery with pediatric laryngeal mask (PLMA) and general tracheal tube (TT) under target-controlled infusion of remifentanil and propofol. Methods A total of 120 children (aged 3-13 years) with elective strabismus were randomly divided into two groups: PLMA group (n = 60) and TT group (n = 60) And propofol into venous anesthesia PLAM or TT. During induction of intubation, the number of limbs movements, coughs, struggles and intubation were observed in both groups. HR, MAP and SPO2 were recorded before induction, after induction, immediately after intubation, and 5 min after extubation. Ppeak and PETCO2 were recorded immediately after intubation, 10 min during surgery, and the eye muscle was pulled. 20 minutes after surgery, two groups of children each took blood from the flexible artery to detect blood gas. Immediately after extubation, the remifentanil and propofol concentrations and the total amount of drugs were recorded. Obstruction was observed after 24 hours of extubation and extubation. Nausea, vomiting, restlessness, excessive sedation, cough, laryngospasm, Department of discomfort and other adverse reactions. Results There was no significant difference in age, sex, height, weight, operation, anesthesia and recovery time between the two groups (P> 0.05). There was no significant difference between HR group and TT group in PLAM group at each time point (P> 0.05). There were different degrees of ocular reflexes in both groups, including HR less than 60 beats / min, PLMA group 28 cases , TT group 27 cases, two cases of each two HR significantly slowed down to 22 ~ 30 times / min. There was no significant difference in Ppeak and PETCO2 between two groups (P> 0.05). Intraoperative blood gas analysis (n = 20) PaCO2 showed PLMA was 44.4 ± 3.1mmHg, TT group was 43.9 ± 2.7mmHg, no significant difference between the two groups (P> 0.05). Induction of choking cough PLMA group 22 cases, TT group 18 cases. Extubation PLMA group occurred in 1 case of gastric reflux from the esophageal passage. Conclusions PLMA is simple and easy to operate. The laryngeal irritation is small during insertion and pull-out of PLMA, hemodynamics is stable during induction and anesthesia, sealing is good and ventilation is reliable. It is suitable for pediatric strabismus anesthesia.