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目的探讨喉罩通气(LMA)在小儿腹腔镜隐睾手术中的应用,并与气管内插管通气(TT)同类手术比较。方法选择腹腔镜小儿隐睾手术120例,随机分为两组,即喉罩组(LMA组)60例和气管插管组(TT组)60例,入室前静脉慢推丙泊芬1～3 mg/kg让患儿安静再入室。全麻诱导维持采用静脉TCI泵分别泵注维持靶控血浆浓度:瑞芬太尼3.5μg/kg/min和丙泊芬(静安)3.5μg/kg/min,并单次静脉注射顺苯阿曲库铵0.1 mg/kg,每45 min可以追加一次。诱导后插入喉罩或气管导管。观察两组患儿在诱导前和LMA(TT)置入前、后及拔除前后的收缩压(sBP)、舒张压(DBP)、心率(HR)的数值,观察监测术中脉搏血氧饱和度(SPO2)、呼气末二氧化碳分压(PETCO2)的变化,并对苏醒情况及气道并发症进行比较。结果 LMA组在置入前后的HR、BP差异无统计学意义(P>0.05);TT组在插管前后的HR、BP差异有统计学意义(P<0.05);2组的气道压力、SPO2、PETCO2比较差异无统计学意义(P>0.05);2组在苏醒时间、气道并发症方面比较,LMA组要优于TT组。结论喉罩通气用于小儿腹腔镜隐睾手术对循环无明显影响,置入简便,通气满意,对气道损伤小,不良反应少,苏醒较快,安全可靠。在小儿麻醉中值得推广。
Objective To investigate the application of laryngeal mask ventilation (LMA) in pediatric laparoscopic cryptorchidism surgery and compare it with the same operation of endotracheal tube ventilation (TT). Methods One hundred and twenty cases of cryptorchidism in children undergoing laparoscopic surgery were randomly divided into two groups: LMA group (n = 60) and tracheal intubation group (group TT): 60 cases. Propofol 1 ~ 3 mg / kg let the children quiet and re-entry. General anesthesia induction was maintained by intravenous TCI pump pump to maintain target-controlled plasma concentrations: remifentanil 3.5μg / kg / min and propofen (Jingan) 3.5μg / kg / min, and a single intravenous injection of cis-benzene Cumonium 0.1 mg / kg, can be added once every 45 min. After induction, insert a laryngeal mask or endotracheal tube. The systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) before and after LMA (TT) implantation and before and after LTP were observed in both groups. The pulse oxygen saturation (SPO2), end-tidal carbon dioxide partial pressure (PETCO2) changes, and wake up and airway complications were compared. Results There were no significant differences in HR and BP before and after LMA injection (P> 0.05). The HR and BP before and after intubation in TT group were significantly different (P <0.05). The airway pressure, SPO2 and PETCO2 had no significant difference (P> 0.05). Compared with TT group, LMA group had better recovery time and airway complication. Conclusion Laryngeal mask ventilation for children with laparoscopic cryptorchidism surgery had no significant effect on circulation, the placement of simple, satisfactory ventilation, less damage to the airways, fewer adverse reactions, rapid recovery, safe and reliable. It is worth promoting in pediatric anesthesia.