I-gel喉罩用于新生儿腹腔镜手术全身麻醉的气道管理

摘要

目的 评价I-gel喉罩用于新生儿腹腔镜手术全身麻醉的气道管理效果.方法 选择行腹腔镜手术的新生儿40例,随机均分为I-gel喉罩组(I组)和气管插管组(E组),各20例.麻醉诱导后,I组患儿置入1号I-gel喉罩,E组患儿插入ID 3.0(或3.5 mm)无套囊气管导管通气,分别记录置入时间和置入成功率,以及置入后不同时间点的血流动力学指标,包括平均动脉压(MAP)、心率(HR)和脉搏血氧饱和度(SpO2);记录置入后的呼气末二氧化碳分压(PETCO2)、气道峰压(Ppeak)和气道密封压;同时记录术后不良反应的发生情况.结果 两组患儿插管(喉罩)成功率差异无显著性(P>0.05);但I组患儿喉罩置入时间显著低于E组患儿的气管插管所需时间(P<0.01).T1时I组患儿MAP、HR较E组明显降低(P<0.05);T1~T3时,与E组比较,I组Pleak显著降低(P<0.01).且I组患儿拔喉罩后不良反应发生率明显少于E组(P<0.05),两组患儿均无反流误吸发生.结论 I-gel喉罩用于新生儿腹腔镜手术全身麻醉的气道管理可取得与气管插管相同的通气效果,且操作便捷,成功率高,并发症少.%Objective To evaluate the effect of I-gel laryngeal mask airway in general anesthesia for lapa-roscopic surgery in neonates. Methods 40 neonates to undergo neonatal laparoscopic surgery were divided into I-gel laryngeal mask group(group I)and tracheal intubation group(group E)randomly,20 in each group. After the induction of anesthesia,I-gel laryngeal mask(size 4 each)was used for ventilation in Group I,and tracheal intu-bation with ID(3.0 or 3.5 mm)was performed for ventilation in group E. The two groups were compared in terms of intubation duration,success rate,the hemodynamic parameters like mean arterial pressure (MAP),heart rate (HR)and plus oxygen saturation(SpO2)at each time point.,the end-tidal carbon dioxide pressure(PETCO2), peak airway pressure (Ppeak),the airway sealing pressure (Pleak),and the postoperative complications. Results There was no significant difference between the two groups in the success rate of intubation (laryngeal mask). However,the duration required for laryngeal mask insertion in I group was significantly shorter than that in E group(P<0.01). MAP and HR were significantly lower than group E at the time point of T1(P<0.05). Pleak in group I was significantly lower than E group at the time points of T1 ~ T3(P < 0.01). The adverse reactions was significantly lower than that in the E group (P < 0.05). There was no reflux aspiration in both groups. Conclusion I-gel laryngeal mask airway can achieve the same effect as tracheal intubation does for general anes-thesia during laparoscopic surgery. It is easy to operate ,with high success rate and few complications.