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The Application of Improved Laryngeal Mask in Fiberoptic Bronchoscopy in Newborns

目的　評價喉罩聯合T型密封接頭通氣在新生兒無痛纖維支氣管鏡（纖支鏡）診治中的臨床效果。 方法　對2010年3月－2012年10月收治的33例擬行纖支鏡診治的新生患兒，分為喉罩組（Ⅰ組）和常規組（Ⅱ組），兩組患兒在術前半小時均靜脈注射咪唑安定0.2～0.3 mg/kg基礎上，Ⅰ組靜脈注射枸櫞酸芬太尼3～5 μg/kg，置入喉罩聯合T型密封接頭通氣下行纖支鏡診治；Ⅱ組常規表面麻醉下行纖支鏡診治。分析術前（T1）、通過聲門（T2）、診治中（T3）、檢查后（T4），脈搏血氧飽和度（SpO2）、心率（HR）的變化情況、纖支鏡從T型密封接頭入口或鼻孔到通過聲門的時間、鏡檢時間、支氣管肺泡灌洗次數、鏡檢期間不良反應（嗆咳、憋氣、肢體運動、呼吸道損傷）及麻醉滿意度（由內鏡醫師評價）。 結果　Ⅰ組與Ⅱ組比較，T1、T4時間點SpO2、HR差異無統計學意義，T2、T3時間點SpO2＜85%、HR＜100次/min的發生率Ⅰ組與Ⅱ組比較差異有統計學意義（P＜0.01）；纖支鏡從T型密封接頭入口或鼻孔到通過聲門時間差異無統計學意義（P＞0.05）；Ⅱ組鏡檢時間短于Ⅰ組，支氣管肺泡灌洗次數少于Ⅰ組；Ⅰ組不良反應低于Ⅱ組，麻醉滿意度高于Ⅱ組（P＜0.05）。 結論　喉罩聯合T型密封接頭通氣在新生兒無痛纖支鏡診治氣道管理安全有效可行，醫師能從容操作。

Comparison of Laryngeal Tube Suction II and LMAProseal for Airway Management in Elective Surgery: Asystematic Review

摘要:目的:評價II代引流型喉管(LTS II)和Proseal喉罩(PLMA)在擇期手術中應用效果。方法:檢索了Cochrane圖書館(2009年第3期)、Pubmed(1950～2009)、EMBase(1989～2009)、CNKI(1979～2009)、VIP(1989～2009)、CBM(1978～2009)中相關II代引流型喉管(LTS II)和Proseal喉罩在擇期手術中應用的隨機對照試驗(RCT),同時篩檢納入文獻的參考文獻。由2名研究者對文獻質量進行嚴格評價和資料提取,根據指標相應異質性進行描述性分析或Meta分析(RevMan 5.0)。結果:共納入3個RCT,共244例研究對象,文獻質量均為B級。3個RCT的結果顯示與PLMA相比,LTS II具有相似的首次置入成功率(P=0.45)、術畢即刻上呼吸道損傷發生率(P=1.00)、術后24 h咽痛發生率(P=0.81)、術后24 h吞咽困難發生率(P=0.12)。2個RCT的結果顯示兩組引流管置入均較容易。1個RCT的結果顯示兩組的操作者主觀評價相近(OR=1.86,95%CI 0.39～ 8.99)。氣道封閉效果由于采用方法學差異性較大,指標也不盡相同,尚不能得出準確結果。結論:LTS II在擇期手術中用于氣道管理具有較好的前景。但是現時仍不宜用于需在擇期術中進行控制通氣的病人。關于氣道封閉效果,尚需采用更合理規范的指標、更高質量的研究設計進一步研究。Abstract: Objective: To assess the efficacy of laryngeal tube suction II (LTS II) and LMAProseal (PLMA) for airway management in elective surgery. Methods:We searched Cochrane Library (2009),Pubmed (19502009)、EMBase (19892009),CNKI (19792009),VIP (19892009),CBM (19782009). The quality of the trials was assessed by two reviewers independently. RevMan 5.0 software provided by the Cochrane Collaboration was used for statistical analysis. Results:Three studies involving 244 participants were included. Same rates of fist successful attempt (P=0.45),upper airway trauma (P=1.00),sore throat (P=0.81) and dysphagia (P=0.12) were observed in LTS II and PLMA in all studies. Two studies indicated that the insertion of gastric tube was easy in both groups. The similarity of subjective maneuverability in two groups was reported in one study (OR=1.86, 95%CI 0.39 to 8.99). The correct result of effectiveness of airway seal could not be made because of various methods and measurements. Conclusion:LTS II have a good perspective in the airway management. Otherwise, it is not safe for patient required control ventilation because of lack of evidence on the effectiveness of airway seal. More RCTs of high quality need to be undertaken in the future.

SLIPATM 喉罩全身麻醉期間誤吸致肺不張一例

婦科腹腔鏡手術通氣策略的研究進展

腹腔鏡在婦科手術中已被廣泛應用，于婦科腹腔鏡手術的麻醉研究也相應增多，而二氧化碳氣腹引起的相關不良反應（高碳酸血癥、低氧血癥、呼吸機相關性肺損傷、術后認知功能障礙等）并未引起麻醉醫生的高度重視。該文通過綜述近年來婦科腹腔鏡手術中不同通氣策略（不同吸入氧濃度、適當增加分鐘通氣量、針對肥胖患者的幾種通氣模式以及喉罩通氣策略）對患者的影響，旨在為婦科腹腔鏡手術乃至其他科室的腹腔鏡手術麻醉管理提供參考依據。

Preoperative Application of Budesonide Aerosol Inhalation in the Reduction of Respiratory Adverse Events during Pediatric Anesthesia Recovery

ObjectiveTo explore the influence of general anesthesia with laryngeal mask and preoperative inhalation of budesonide aerosol on the incidence of respiratory adverse events during pediatric anesthesia recovery. MethodsA total of 100 child patients scheduled to undergoing inguinal hernia repair between December 2012 and February 2014 were randomly divided into two groups (group A and B) with 50 in each. All the patients underwent general anesthesia with laryngeal mask, while patients in group B inhaled budesonide aerosol before anesthesia. Then, we observed the incidence of adverse events in both groups, including laryngospasm, respiratory tract infection, and pulmonary complications. ResultsCompared with group A, patients in group B had a lower incidence of adverse events (P<0.05). ConclusionPreoperative application of budesonide aerosol inhalation can significantly reduce adverse events in the process of anesthesia recovery in children.

Application of Laryngeal Mask Airway General Anesthesia in Lateral Operation on Children

【摘要】　目的　比較喉罩全麻與氣管插管全麻兩種麻醉方法在小兒側臥位短小手術中的優缺點。　方法　2009年6月-2010年2月，將40例擇期行側臥位短小手術兒患，隨機分為喉罩全麻（L）組與氣管插管全麻（T）組，每組各20例。觀察患兒術中心率（HR）、平均動脈壓（MAP）、脈搏血氧飽和度（SpO2）、氣道峰壓（Pmax），惡心嘔吐、術后躁動等圍術期不良反應。　結果　T組插管后及拔管后即刻HR、MAP均高于L組患兒（Plt;0.05）；SpO2、Pmax在兩組之間比較差異無統計學意義（Pgt;0.05），T組患兒術后躁動發生率明顯高于L組（Plt;0.05）。　結論　喉罩可以安全、有效地用于小兒側臥位短小手術麻醉，且操作簡便，插管期和拔管期心血管應激反應輕，術后躁動發生率低。【Abstract】　Objective　To compare the safety and efficacy of laryngeal mask airway (LMA) and tracheal tube in lateral general anesthetic operation on children.　Methods　From June 2009 to February 2010, 40 children scheduled to undergo general anesthesia for minor surgical procedures in lateral position were randomly divided into the laryngeal mask airway group (group L) and the tracheal tube group (group T) with 20 in each. Heart rate (HR), mean arterial pressure (MAP), pulse oxygen saturation (SpO2), top airway pressure (Pmax) of the patients were observed. In addition, side effects such as nausea, vomiting, and emergence agitation were also recorded.　Results　HR and MAP of patients in group T were significantly higher than those of patients in group L after intubation and after extubation (Plt;0.05). There was no difference in Pmax and SpO2 between the two groups (Pgt;0.05). The incidence of emergence agitation in group T was significantly higher than that in group L.　Conclusions　LMA intubation can provide the same safe and effective ventilation as tracheal intubation for children undergoing lateral general anesthetic operation. LMA is superior to tracheal intubation in insertion response, and the incidence of emergence agitation is lower.

Application of Laryngeal Mask Combined with Sevoflurane in Painless Fiberoptic Bronchoscopy Anesthesia in Children

【摘要】 目的 比較喉罩和氣管內插管吸入七氟烷全麻用于小兒無痛苦纖支鏡檢查的麻醉效果、蘇醒時間、蘇醒質量。 方法 將2008年3月-2009年3月40例行纖支鏡檢查的患兒隨機分為喉罩組（L組，21例）和氣管內插管組（T組，19例）。兩組均采用逐漸誘導法吸入七氟烷，靜脈給予芬太尼1 μg/kg；L組置入喉罩，T組氣管插管后控制呼吸。手術中，兩組均吸入2%～5%七氟烷維持麻醉。分別記錄麻醉前（T0）、麻醉后纖支鏡進入前（T1）、進鏡至咽部（T2）、聲門部（T3）、氣管內（T4）及第15 min（T5）時的血壓（BP）、心率（HR）、MAP和動脈血氧飽和度（SPO2）。觀察纖支鏡檢查期間有無嗆咳、氣道痙攣或體動；記錄停藥至拔管的時間，蘇醒后是否再入睡及麻醉滿意度。 結果 兩組HR在T1、T3、T4時升高，與T0時比較，有統計學意義（Plt;0.05）；其中HR在T1時T組高于L組，組間比較有統計學意義（Plt;0.05）；MAP在T1、T2、T3、T4時，T組低于L組，組間比較有統計學意義（Plt;0.05）。兩組患兒鏡檢期間均無嗆咳、氣道痙攣或體動；L組蘇醒時間短于T組（Plt;0.05），蘇醒后再入睡率低于T組（Plt;0.05），麻醉滿意度高于T組（Plt;0.05）。 結論 喉罩吸入七氟烷全麻用于小兒無痛苦纖支鏡檢查，能保證穩定的血流動力學狀態，蘇醒快速，效果滿意。【Abstract】 Objective To assess the feasibility and safety of Laryngeal mask combined with sevoflurane in painless fiberoptic bronchoscopy anesthesia in children. Methods Forty children from March 2008 to March 2009 were randomized divided into laryngeal mask airway group (group L) and endotracheal intubation group (group T). Anaesthesia was induced and maintenanced with 2%-5% sevoflurane and fentanyl 1 μg/kg. The blood pressure (BR), heart rate (HR) and oxygen saturation by pulse oximeter (SPO2)were recorded before anaesthesia (T0), immediately after anaesthesia induction (T1), when FOB at the level of pharynx(T2), vocal cords (T3), trachea (T4) and in 15 min of the FOB (T5). Extubation time, recovery quality and anesthesia effects were also analyzed. Results Compared with T0, there were significant increases in HR at T1、T3 and T4 (Plt;0.05), and HR was significantly higher in the group T than that in the group L at T1 (Plt;0.05). MAP was significantly lower in group T than that in group L at T1、T2、T3 and T4, respectively(Plt;0.05). Recovery time was significantly shorter in group L than that in group T. Incidence of sleep after recovery was lower in group L than that in group T. Anesthesia satisfaction was higher in the group L than that in the group T. Conclusions Laryngeal mask combined with Sevoflurane provide satisfactory anesthesia for painless fiberoptic bronchoscopy in children.

改良彎接頭連接喉罩全身麻醉在小兒纖維支氣管鏡檢查中的應用

目的探討改良螺紋管彎接頭連接普通喉罩用于全身麻醉下小兒纖維支氣管鏡檢查的有效性及安全性。 方法2012年11月－2013年8月行小兒纖維支氣管鏡檢查的患兒36例，采用改良彎接頭連接喉罩行七氟醚吸入全身麻醉下小兒纖維支氣管鏡檢查。 結果36例患兒檢查均順利結束，檢查中無檢查中斷發生，無組織損傷，無喉痙攣及支氣管痙攣，無喉頭水腫，無血氧飽和度降低至90%以下。 結論改良螺紋管彎接頭連接喉罩用于小兒纖維支氣管鏡檢查簡單價廉，能有效保證氧供，尤其適用于基層醫院開展。

食管引流型喉罩的臨床應用進展

食管引流型喉罩又稱為雙管喉罩，為第三代喉罩。目前臨床上廣泛應用的食管引流型喉罩包括3種：Proseal喉罩，在Proseal喉罩基礎上加以改進的Supreme喉罩以及無套囊的I-gel喉罩。食管引流型喉罩的主要特點為增加了一根對胃腸道起到密封和引流作用的引流管，并對通氣罩進行了改進。因此食管引流型喉罩具備防止返流誤吸的作用，并改善了通氣功能。目前，食管引流型喉罩除了廣泛應用于全身麻醉下成人、兒童的短小體表和四肢手術，還進一步應用到腹腔鏡手術、腹部外科開放性手術、肥胖患者的手術、困難氣管等領域。其應用的有效性和安全性大大提高, 將逐漸取代普通喉罩。本文就食管引流型喉罩的應用進展作一綜述，便于臨床醫生更方便、更快捷的掌握食管引流型喉罩使用技術，并在臨床上進一步推廣。

喉罩-超短效麻醉藥在小兒短小手術中的應用

【摘要】　目的　比較喉罩-七氟醚、雷米芬太尼與喉罩-丙泊酚、雷米芬太尼兩種麻醉方法在小兒短小手術應用中的優缺點。　方法　2009年3-9月，將40例擇期行斜疝手術或隱睪下降固定術的患兒，隨機分為A、B組，各20例。A組施喉罩+七氟醚+雷米芬太尼，B組施喉罩+丙泊酚+雷米芬太尼。觀察誘導時間、術中生命體征、蘇醒時間、麻醉后恢復室（PACU）停留時間、圍術期并發癥。　結果　麻醉前兩組患兒血壓及心率無統計學差異，麻醉后B組各時點血壓及心率明顯低于麻醉前水平，且B組各時點血壓及心率明顯低于A組，A組血壓及心率在麻醉前后比較無統計學差異。B組麻醉誘導時間明顯短于A組。A組術后躁動發生率明顯高于B組。　結論　與喉罩+丙泊酚+雷米芬太尼相比，喉罩+七氟醚+雷米芬太尼具有對全身影響小、麻醉平穩等特點，但麻醉誘導時間長，術后躁動發生率高。