Study of the laryngeal mask airway for airway management in children with acute severe tracheobronchial foreign body
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摘要: 目的:探讨喉罩在儿童急重症气管、支气管异物取出术后呼吸道管理中的应用,为临床提供安全有效的治疗方案。方法:选择急重症气管、支气管异物手术需要机械通气过度的70例患儿,随机分气管插管(TT)组和喉罩(LMA)组,每组35例。全身麻醉诱导相同:经静脉推注咪达唑仑0.02 mg/kg,芬太尼0.002 mg/kg,丙泊酚2.0 mg/kg,阿曲库铵0.2 mg/kg,地塞米松1 mg/kg,上支气管镜后接呼吸机行控制呼吸。术中采用丙泊酚持续泵注,间断给予阿曲库铵。手术完成拔出支气管镜分别在气管插管、喉罩置入操作下行呼吸道管理。观察2组患儿在诱导前和LMA(TT)置入前后及拔除前后的平均动脉压、心率,观察监测术中潮气量、呼吸频率、动脉血氧饱和度、呼气末二氧化碳分压的变化并对苏醒情况及气道并发症进行比较。结果:LMA组置入前后的心率、血压无明显差异(P>0.05);TT组插管前后的心率、血压差异有统计学意义(P<0.05);2组的气道压力、动脉血氧饱和度、呼气末二氧化碳分压比较差异无统计学意义(P>0.05);气道并发症方面,LMA组要优于TT组(P<0.01)。结论:LMA用于小儿气管、支气管异物的呼吸道管理对呼吸循环无明显影响,对气道损伤小,苏醒较快,优于TT,值得推广。Abstract: Objective: To explore the application of laryngeal mask airway in the management of respiratory tract after acute and severe tracheal foreign body removal in children, and to provide a safe and effective treatment for clinical treatment.Method: Seventy cases of children with acute severe tracheal or bronchial foreign body requiring mechanical ventilation transition were randomized to receive, one group was using laryngeal mask airway for airway management after the foreign body was extracted and the bronchoscope was pulled out. Another group was using tracheal intubation. Both groups were received the same general anesthesia induction and maintenance. The blood pressure before induction, before and after insertion of LMA (TT), before and after extubation of LMA(TT) were monitored and recorded. Heart rate, tidal volume,respiratory rate,pulse oxygen saturation,and end-tidal carbon dioxide partial pressure were recorded at the same time in both groups. Airway complications during the recovering between two groups were compared.Result: HR, BP have no significant difference in LMA group before and after implantation LMA (P>0.05).HR and BP were increased significantly after intubation(P<0.05) in TT group; Airway pressure, SpO2 and PETCO2 exhibited no significant difference between two groups(P>0.05); LMA group has less airway complications than TT group during the recovering.Conclusion: Application of LMA for anesthetic airway management after tracheobronchial foreign body was extracted in children made both less effect on respiratory and circulatory system the regular using tracheal intubation and less damage to the respiratory tract. In addition,the recovery time in LMA group is much shorter than that of TT group.
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Key words:
- laryngeal mask airway /
- general anesthesia /
- tracheal intubation /
- children /
- foreign body
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