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ProSeal^(TM)喉罩通气道应用于超快通道小儿心脏麻醉的可行性 被引量:10

Feasibility of Using ProSeal^(TM) Laryngeal Mask Airway in Ultra-Fast-Track Pediatric Cardiac Anesthesia
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摘要 目的探讨ProSealTM喉罩通气道(PLMA)应用于超快通道小儿心脏麻醉的可行性和安全性。方法选取实施择期心脏手术的患儿40例,年龄6个月~5岁,均为美国麻醉医师协会(ASA)身体状况分级Ⅱ级。患儿按体质量分为2组,Ⅰ组(20例):体质量5~10kg,插入1.5号PLMA;Ⅱ组(20例):体质量>10~20kg,插入2.0号PLMA。采用80mL.L-1七氟烷实施吸入麻醉诱导,采用持续静脉泵入瑞芬太尼和异丙酚及吸入七氟烷维持麻醉,静脉应用维库溴铵维持肌肉松弛。结果术中全部患儿采用容量控制通气,并能达到设定的潮气量而无漏气。插入PLMA后,患儿总呼吸道峰压为(15.8±4.2)cmH2O(1cmH2O=0.098kPa);Ⅰ组插入PLMA后呼吸道峰压明显高于Ⅱ组[(18.9±3.8)cmH2Ovs(12.8±1.7)cmH2O,P<0.05]。Ⅱ组PLMA插入后的呼吸道峰压明显低于胸骨闭合后[(12.8±1.7)cmH2Ovs(16.5±3.8)cmH2O,P<0.05]。停机前,全部患儿肺复张膨肺采用的呼吸道压为25~35cmH2O,肺复张满意,且无脱离体外循环后低氧血症。全部患儿在手术室内拔除PLMA,PLMA使用的平均时间为(174.7±30.9)min。虽然拔出PLMA前后的脑电双频指数、血压和心率变化比较差异有统计学意义,但各参数的变化均小于10%。术后X线胸片检查无异常。结论 PLMA应用于超快通道小儿心脏手术麻醉是可行且相对安全的。 Objective To explore the feasibility and safety of using ProSealTM laryngeal mask airway (PLMA) in ultra - fast - track pediatric cardiac anesthesia. Methods Forty children [ American Society of Anesthesiologists(ASA) Ⅱ ,aged from 6 months to 5 years old ] were scheduled for undergoing cardiac operation, and were divided into 2 groups. In group I [ n = 20, weight (5 - 10) kg ] ,a size 1.5 PLMA was used, and in group Ⅱ [ n = 20, weight ( 〉 10 - 20 ) kg ], a size 2.0 PLMA was used, respectively. Anesthesia was induced with inhalation of 80 mL · L-1 sevoflurane and maintained with infusion of remifentanil and propofol and inhalation of sevoflurane. Muscle relaxation was maintained by intravenous administration of vecuronium. Results All children were ventilated with a tidal volume of 10 mL · kg- 1 without air leak. Average peak airway pressure for all children was ( 15.8 ±4.2) cmH20. Average peak airway pressure in group I was higher than that in group Ⅱ after insertion [ ( 18. 9± 3.8 ) cmH20 vs ( 12.8± 1.7 ) cmH2 O, respectively ( P 〈 0.05 ) ]. In group Ⅱ , the peak airway pressure after insertion was significantly lower following sternal closure[ ( 12.8 ± 1.7 ) cmH2O vs ( 16.5± 3.8 ) cmH20, respectively ( P 〈 0.05 ) ]. Lung inflation at pressure of 25 -35 cmH20 for alveolar recruitment was efficient during weaning off cardopulmonary bypass and no hypoxia occurred after cardopulmonary bypass. The average placement time of PLMA was ( 174.7 _+ 30.9 ) min. Although the difference was significant, the changes in hemodynamics and bispectral index were less than 10% before and after removal of PLMA. Postoperative chest X - ray was normal. Conclusion PLMA is feasible and relatively safe for pediatric cardiac patients undergoing ultra - fast - track anesthesia.
出处 《实用儿科临床杂志》 CAS CSCD 北大核心 2010年第11期798-800,共3页 Journal of Applied Clinical Pediatrics
基金 "十一.五"国家科技支撑计划项目(2006BAI01A08)
关键词 ProSealTM喉罩通气道 超快通道小儿心脏手术 全身麻醉 体外循环 ProSealTM laryngeal mask airway ultra - fast - track pediatric cardiac surgery general anesthesia cardopulmonary bypass
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参考文献16

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二级参考文献14

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