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目的比较喉罩和气管内插管吸入七氟烷全麻用于小儿无痛苦纤支镜检查的麻醉效果、苏醒时间、苏醒质量。方法将2008年3月-2009年3月40例行纤支镜检查的患儿随机分为喉罩组(L组,21例)和气管内插管组(T组,19例)。两组均采用逐渐诱导法吸入七氟烷,静脉给予芬太尼1μg/kg;L组置入喉罩,T组气管插管后控制呼吸。手术中,两组均吸入2%～5%七氟烷维持麻醉。分别记录麻醉前(T0)、麻醉后纤支镜进入前(T1)、进镜至咽部(T2)、声门部(T3)、气管内(T4)及第15min(T5)时的血压(BP)、心率(HR)、MAP和动脉血氧饱和度(SpO2)。观察纤支镜检查期间有无呛咳、气道痉挛或体动;记录停药至拔管的时间,苏醒后是否再入睡及麻醉满意度。结果两组HR在T1、T3、T4时升高,与T0时比较,有统计学意义(P<0.05);其中HR在T1时T组高于L组,组间比较有统计学意义(P<0.05);MAP在T1、T2、T3、T4时,T组低于L组,组间比较有统计学意义(P<0.05)。两组患儿镜检期间均无呛咳、气道痉挛或体动;L组苏醒时间短于T组(P<0.05),苏醒后再入睡率低于T组(P<0.05),麻醉满意度高于T组(P<0.05)。结论喉罩吸入七氟烷全麻用于小儿无痛苦纤支镜检查,能保证稳定的血流动力学状态,苏醒快速,效果满意。
Objective To compare anesthesia, recovery time and awakening quality of laryngeal mask and endotracheal intubation sevoflurane anesthesia for pediatric painless bronchoscopy. Methods From March 2008 to March 2009, 40 children undergoing fiberoptic bronchoscopy were randomly divided into laryngeal mask group (L group, 21 cases) and endotracheal intubation group (T group, 19 cases). In both groups, sevoflurane was inhaled gradually by induction method and fentanyl 1μg / kg was given intravenously. L group was placed in laryngeal mask, T group was controlled by intubation after tracheal intubation. During surgery, both groups received 2% to 5% sevoflurane to maintain anesthesia. The blood pressure before anesthesia (T0), before anesthesia (T1), into the pharynx (T2), glottis (T3), endotracheal tube (T4) and 15min BP), heart rate (HR), MAP and arterial oxygen saturation (SpO2). Observed during bronchoscopy with or without cough, airway spasms or physical activity; record withdrawal to extubation time, whether to sleep again after anesthesia satisfaction and satisfaction. Results The HR of both groups increased at T1, T3 and T4, compared with that at T0 (P <0.05). The HR at T1 was higher in group T than in group L (P <0.05). MAP was lower at T1, T2, T3, T4 in T group than in L group (P <0.05). There was no cough, airway spasm or body movement during the microscopic examination in both groups. The recovery time in group L was shorter than that in group T (P <0.05), and the rate of falling asleep after recovery was lower than that in group T (P <0.05) Degree higher than T group (P <0.05). Conclusion Laryngeal mask inhalation of sevoflurane anesthesia for children without painful bronchoscopy, to ensure stable hemodynamic status, wake up quickly, the effect is satisfactory.