喉罩联合骶管阻滞用于婴幼儿腹腔镜结肠手术麻醉的安全性和可行性

【目的】探讨喉罩联合骶管阻滞用于婴幼儿腹腔镜先天性巨结肠根治手术的安全性和可行性。【方法】选择2008年1月至2011年3月择期拟行腹腔镜下先天性巨结肠根治术的患儿48例（ASAⅠ～Ⅱ级），根据麻醉方式的不同随机分为四组（n=12）。（A组）：食管引流型喉罩＋骶管阻滞联合全麻组，（B组）：气管导管＋骶管阻滞联合全麻组，（C组）：食管引流型喉罩＋全麻组，（D组）：气管导管＋全麻组。比较各组麻醉期间血流动力学及血气变化、麻醉期间呼吸力学参数变化、麻醉苏醒质量及不良反应。【结果】各组气腹前后血流动力学波动不明显；气腹后四组的气道峰压、平台压均明显高于气腹前（P〈0．05）。气腹后A组、c组的漏气率明显高于B组和D组（P〈0．05）。四组自主呼吸恢复时间无明显差异，A组、B组睁眼时间、拔除喉罩或导管时间明显短于D组（P〈0．05）。A、B、C三组OAAS评分达5级时间明显短于D组（P〈0．05）。各组围麻醉手术期均未出现严重并发症。【结论】食管引流型喉罩通气联合骶管阻滞用于婴幼儿腹腔镜先天性巨结肠手术的麻醉安全可行，不良反应发生率低。

Safety and Feasibility of Laryngeal Mask Combined with Caudal Block in Anesthesia of Infant Laparoscopic Colon Surgery

Objective] To explore the safety and feasibility of laryngeal mask combined with caudal block in laparoscopic radical operation of infants with congenital megacolon. Methods] Forty-eight infants with congenital megacolon undergoing elective laparoscopic radical operation（ASA I or II） from Jan. 2008 to March 2011 were enrolled in this study. According to the anesthetic methods, the patients were randomly divided into four groups with 12 cases in each group. Group A received the combined general anesthesia of laryngeal mask plus caudal block. Group B received the combined general anesthesia of endotracheal catheter plus caudal block. Group C received laryngeal mask plus general anesthesia. Group D received endotracheal catheter plus general anesthesia. The hemodynamics, blood gas, the parameters of respiratory mechanics, the quality of anesthesia consciousness and side effects were compared among these groups. Results]The change of hemodynamics in each group was not significant before and after pneumoperitoneum. Peak inspiratory pressure and airway plateau pressure in 4 groups after pneumoperitoneum were significantly higher than those before pneumoperitoneum（ P 〈0.05）. After pneumoperitoneum, the leakage rate in group A and group C were significantly higher than those in group B and group D（ P 〈0.05）. There was no significant difference in recovery time of spontaneous breathing among 4 groups（ P 〉0.05）. The time of opening the eyes and the removal time of laryngeal mask or catheter in group A and group B were obviously shorter than those in group D（ P 〈0.05）. The time of OAA/S score up to degree 5 in group A, B and C were shorter than that in group D（ P〈0.05）. No severe perioperative complications in each group occurred. Conclusion] Laryngeal mask ventilation combined with caudal block in laparoscopic radical operation of infants with congenital megacolon is safe and feasible with low side effects.