喉罩在小儿腹腔镜疝囊高位结扎术中的应用及其对血流动力学、复苏时间的影响

摘要

目的 探讨喉罩在小儿腹腔镜疝囊高位结扎术中的应用及其对患儿血流动力学、复苏时间的影响.方法 回顾性分析2017年7月至2018年7月在广东省东莞市人民医院行腹腔镜疝囊高位结扎术的82例患儿的临床资料,根据是否应用喉罩分为喉罩组(n=41)和气管插管组(n=41),其中喉罩组患儿经全身麻醉诱导后置入喉罩,气管插管组患儿经全身麻醉诱导后置入气管插管.比较分析两组患儿喉罩或气管导管置入前10min(T0)、置入时(T1)、置入后5min(T2)、拔出时(T3)、拔出后10min(T4)的心率(heart rate,HR)、平均动脉压(mean arterial pressure,MAP)、脉搏血氧饱和度(pulse oxygen saturation,SpO2)等血流动力学参数,喉罩或气管导管置入后5min、间歇正压通气10min、气腹后10min时的气道峰压(Ppeak)、吸气平台压(Pplat)和呼气末二氧化碳分压(PETCO2)等呼吸相关参数,并比较两组的术后复苏时间、躁动情况及并发症发生情况.结果 在T0时两组患儿的HR、MAP和SpO2比较差异无显著性(P＞0.05).在T1、T2、T3、T4时两组患儿的SpO2差异无显著性(P＞0.05),而喉罩组的HR和MAP明显低于气管插管组,差异有显著性(P＜0.05).两组患儿气腹后10min的Pplat、Ppeak、PETCO2明显高于喉罩或气管导管置入后5min及间歇正压通气10min时,差异有显著性(P＜0.05).而喉罩组喉罩置入后5min、间歇正压通气10min、气腹后10min时的Pplat、Ppeak、PETCO2均明显低于气管插管组,差异有显著性(P＜0.05).喉罩组患儿的复苏时间明显短于气管插管组,躁动发生率(4.88％)明显低于气管插管组(31.71％),并发症发生率(9.76％)也明显低于气管插管组(43.90％),差异均有显著性(P＜0.05).结论 在小儿腹腔镜疝囊高位结扎术中应用喉罩可明显改善患儿的血流动力学和呼吸相关参数,缩短复苏时间,降低躁动和并发症发生率,值得临床推广应用.%Objective To explore the application of laryngeal mask in laparoscopic high ligation of hernia sac in children and its in? uence on hemodynamics and resuscitation time. Method The clinical data of 82 children undergoing laparoscopic high ligation of hernia sac from July 2017 to July 2018 were retrospectively analyzed. They were divided into laryngeal mask group (n=41) and tracheal intubation group (n=41). The laryngeal mask group was induced by general anesthesia and the tracheal intubation group was induced by general anesthesia. The hemodynamics, respiratory parameters, resuscitation time, restlessness and complications of the two groups were compared and analyzed. Result There was no signi?cant difference in the HR, MAP and SpO2 at the T0 time between the two groups (P＞0.05).There was no significant difference in SPO2 between the two groups at T1, T2, T3 and T4 (P＞0.05), but HR and MAP in the laryngeal mask group were signi?cantly lower than those in the tracheal intubation group (P＞0.05). The Pplat, Ppeak and PETCO2 in 10 minutes after pneumoperitoneum in the two groups were signi?cantly higher than those at T2 and 10 minutes after intermittent positive pressure ventilation (P＜0.05). The levels of Pplat, Ppeak and PETCO2 in laryngeal mask group at T2, intermittent positive pressure ventilation for 10 minutes and 10 minutes after pneumoperitoneum were signi?cantly lower than those in tracheal intubation group (P＜0.05). The recovery time of laryngeal mask group was signi?cantly lower than that of endotracheal intubation group; 2 cases (4.88％) of laryngeal mask group had restlessness, 13 cases (31.71％) of endotracheal intubation group had restlessness, while that of laryngeal mask group was signi?cantly lower than that of control group (P＜0.05). The incidence of complications was 9.76％ in laryngeal mask group and 43.90％ in endotracheal intubation group. The incidence of complications in laryngeal mask group was signi?cantly lower than that in endotracheal intubation group (P＜0.05). Conclusion The application of laryngeal mask in laparoscopic high ligation of hernia sac in children can signi?cantly improve the hemodynamics and respiratory related parameters, reduce the recovery time, reduce the incidence of restlessness and complications, which is worth promoting in clinical practice.