喉罩置管静脉全麻在小儿腹腔镜斜疝内环口缝扎手术中的应用

目的探讨喉罩置管静脉全麻在小儿腹腔镜斜疝内环口缝扎手术中的应用。方法 40例ASAⅠ～Ⅱ级2～6岁行择期腹腔镜疝内环口缝扎手术患儿,随机分LMA喉罩组（L组）和气管插管组（E组）,每组20例,两组均静脉注射咪达唑仑0.2mg/kg入睡后推入手术室,采用静脉注射丙泊酚2mg/kg、芬太尼3μg/kg、阿曲库铵0.6mg/kg诱导后置入喉罩或气管插管。观察围麻醉期的MAP、HR、SpO2、PETCO2变化及并发症情况。结果两种方法都能满意地完成手术的麻醉,L组在置入期和拔除期HR、MAP的变化较E组小（P〈0.05和P〈0.01）,两组的SpO2、PETCO2变化差异无显著性（P〉0.05）,术毕至拔管时间两组比较有显著差异（P〈0.05）,L组苏醒期躁动、呛咳、拔管后低气血症、咽痛不适、术后声嘶明显少于E组（P〈0.01）。结论喉罩置管静脉全麻应用于小儿腹腔镜斜疝内环口缝扎手术,具有置入方便、通气满意、血流动力学更平稳、不良反应少、安全可靠的优点。

Application of LAM With General Anesthesia during Laparoscopic Inguinal Hernia Repair Surgery for Children

Objective To explore the application of LAM with general anesthesia during laparoscopic inguinal hernia repair surgery for children.Methods 40 patients（ASA I ～ II）,who needed laparoscopic inguinal hernia repair surgery from 2 to 6 years old,were randomly divided into LMA group（group L） or endotracheal intubation group（group E）（n=20）.Anesthesia was induced with midazolum 0.2 mg/kg,propofol 2 mg/kg,fentanyl 3 μg/kg and atracurium 0.6 mg/kg intravenously,and LMA in group L and endotracheal tube in group E were placed.MAP,HR,SpO2,PETCO2 and complications were observed during anesthesia.Results Anesthesia was satisfied during surgery in the two groups.The change of HR and MAP in group L decreased less than that in group E during insertion and removal（P 0.05,P 0.01） and there was no significant difference in SpO2 and PETCO2 between the two groups（P 0.05）.The time from postoperation to extubation was significantly different between the two groups（P 0.05）.Restlessness and bucking during analepsia,low pneumohemia,pharyngalgia and trachyphonia after extubation in group L decreased less than that in group E.Conclusion LAM with general anesthesia had many advantages such as convenient placement,excellent ventilation,stable hemodynamics,low adverse reaction and high security when it was applied during laparoscopic inguinal hernia repair surgery for children.