纤维支气管镜用于腹腔镜小儿喉罩插入辅助定位的研究

目的 探讨纤维支气管镜(FOB)用于不同方法小儿喉罩插入时的辅助定位,验证不同方法小儿喉罩插入的到位率,也提高小儿喉罩通气技术的安全性.方法 180例ASAⅠ级~Ⅱ级拟在静脉全身麻醉下行腹腔镜小儿手术患者,随机分为Ⅰ组(盲插喉罩)、Ⅱ组(喉镜明视下提起会厌暴露咽腔置入喉罩),每组90例.两组的麻醉诱导和维持药物一样.两组都采用纤维支气管镜验证喉罩插入位置的到位率,对插入喉罩位置不理想者进行调整,观察记录两组置入喉罩方法的置入时间、置入一次成功率以及喉罩置入前、置入时、置入后5 min时HR和MAP的变化.结果 Ⅱ组的喉罩置入时间短、置入的一次成功率高(P<0.05).两种喉罩置入方法置入前后的血流动力学变化显示:与置入前比较,Ⅰ组置入时MAP和HR升高幅度较小(P>0.05),Ⅱ组置入时MAP和HR升高明显(P<0.05),两组置入后5 min时MAP和HR没有大的变化(P>0.05).Ⅰ组经纤维支气管镜直视下调整喉罩后所能达到1级者较之调整前明显增加(P<0.05);Ⅱ组无统计学意义(P>0.05).结论 两组插入喉罩方法都有优缺点,如果联合纤维支气管镜对小儿喉罩辅助定位可以显著提高小儿喉罩插入的到位率,也提高小儿喉罩通气技术的安全性.

Fiberoptic bronchoscopy for laparoscopic of laryngeal mask airway insertion in children-aided positioning research

Objective Study on fiberoptic Bronchoscopy（FOB） for different methods of laryngeal mask airway insertion in children secondary location,verify that the different methods in place the rate of laryngeal mask airway insertion in children,improving the technical security of laryngeal mask airway in children.Methods ASA level Ⅱ grade Ⅰ~180 cases intended for intravenous general anesthesia laparoscopic surgery for pediatric patients,randomly divided into I Group（blind plug laryngeal mask）,II Group（laryngoscope photopic lift the epiglottis exposed pharyngeal placed under laryngeal mask）,90 cases in each group.Anesthesia induction and maintenance of two groups of drugs,both groups with fiberbronchoscope authentication in place the rate of laryngeal mask insertion position,make adjustments to the location of the insertion of laryngeal mask undesirable,observe records placed two groups of laryngeal mask placed time,placed on the methods of success rates as well as laryngeal mask placed before,on place,when you place a 5 min after changing HR and MAP.Results Group Ⅱ laryngeal mask place a short time,the success rate of placing high（P〈0.05）.Two methods of laryngeal mask placed placing of hemodynamic changes before and after shows and placed earlier,elevated Ⅰ Group HR and place MAP smaller（P〉0.05）,Ⅱ place set MAP and HR rises significantly（P〈0.05）,placed the two groups MAP and HR 5 min after no major change（P〉0.05）.I set upon adjustment of fibrobronchoscopy under laryngeal mask airway,can achieve level 1 compared with the adjusted increased significantly before（P0.05）,Ⅱ groups was not statistically significant（P〉0.05）.Conclusion Two insert laryngeal mask methods have advantages and disadvantages.If bronchoscopy in children with laryngeal mask airway secondary orientation can significantly increase the rate of laryngeal mask airway insertion in children,improving the technical security of laryngeal mask airway in children.