喉罩与气管插管通气在小儿腹腔镜手术麻醉中对血流动力学的影响比较

目的观察全身麻醉诱导后管入喉罩通气与气管插管通气在小儿腹腔镜手术麻醉中对血流动力学的影响。方法选择择期行腹腔镜手术的小儿40例，年龄3～10岁，ASAⅠ～Ⅱ级，阑尾切除手术17例，斜疝修补术12例，精索静脉曲张血管结扎术5例，胆囊切除2例，Meckel憩室切除4例；根据建立通气方式不同将患儿随机分为两组：E组（气管插管）20例和L组（喉罩，LMA）20例。用PHILIPS多功能监护仪连续监测收缩压（SBP）、舒张压（DBP）、心率（HR）、心电图（ECG）和脉搏血氧饱和度（SpO2）。记录诱导前安静状态（T0）、麻醉诱导后（T1）、喉罩置入或插管即刻（T2）、拔管前（T3）及拔管后（T4）5个时点SBP、DBP及HR值。结果E组气管插管后各时间点SBP、DBP、HR均显著增高（P〈0．01）；L组喉罩置入后各时间点SBP、DBP、HR虽有所增高，但与基础值比较差异无显著性（P〉0．05）。结论小儿腹腔镜手术麻醉中，应用喉罩安全方便，较直接喉镜下气管插管对心血管的不良刺激小，值得推广。

Effects of Hemodynamics of General Anesthesia by Laryngeal Mask Airway or Endotracheal Intubation on the Children with the Laparoscopic Operation Anesthesia

Objective To investigate the effects of hemodynamics of general anesthesia induced by laryngeal mask airway or endotracheal intubation on the children with the laparoscopic operation.Methods 40 patients aged 3 to 10 ranged as ASA Ⅰ - Ⅱ .were be researched in this study,among them, 17 cases were appendectomy, 12 cases were hernia repair resection,5 cases were Varicocele, 2 cases were cholecystectomy, 4 cases were Meckel＇s diverticulum resection; all the patients were randomly assigned to two groups （E group, 20 cases of Endotracheal Intubation, and L group ,20 cases with Laryngeal Mask Airway, LMA）. Applying PHILIPS Multi-function monitor to continuously monitor systolic blood pressure （SBP）, diastolic blood pressure （DBP）, heart rate （HR）, electrocardiogram （ECG） and pulse oxygen saturation （SpO2） of the patient. The SBP, DBP and HR on five time point （T0：quiet state before induction,T1 ：after induction of anesthesia,T2：laryngeal mask insertion,or immediate intubation,T3：before extubation,T4：after extubation） were recorded .Results In the E group,the SBP, BP, HR on each time point after orotracheal intubation increased significantly （P〈0.01）,in the L group, the SBP,DBP,HR at different time points after LMA increased a little, however, compared with the basis value, the difference was not significant（P〉0.05）.Conclusion It is safe and convenient using ventilation with Laryngeal mask in the pediatric laparoscopic operation,and contrast to the endotracheal intubation, the harmful effect on hemodynamics of ventilationwith Laryngeal mask is little.