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目的比较喉罩和气管内插管瑞芬太尼复合丙泊酚全麻用于小儿纤维支气管镜诊疗的临床应用效果。方法拟行纤维支气管镜诊疗的小儿40例,随机分为喉罩组(L组,n=20)和气管内插管组(T组,n=20)。两组均采用瑞芬太尼和丙泊酚静脉麻醉诱导和维持,术中监测心电图、心率、无创动脉血压、脉搏氧饱和度。分别记录麻醉前(T0)麻醉后纤维支气管镜进入前(T1)、进镜至声门(T2)、气管隆突(T3)及第10min(T4)及术毕(T5)的心率(HR)、平均动脉压(MAP)和动脉血氧饱和度(SpO2),观察术中有无呛咳、喉及支气管痉挛、体动;记录两组患儿呼吸恢复时间、清醒时间及拔管时间;记录麻醉满意度(由镜检医师评价)。结果两组HR在T1时升高,与T0比较,差异有统计学意义(P﹤0.05);T组高于L组,组间比较差异有统计学意义(P﹤0.05)。MAP在T2～T4时,T组低于L组,比较差异有统计学意义(P﹤0.05)。两组患儿镜检期间均无呛咳、喉及支气管痉挛或体动。L组患儿呼吸恢复时间、清醒时间及拔管时间均短于T组,差异有统计学意义(P﹤0.05)。结论喉罩-瑞芬太尼复合丙泊酚麻醉用于小儿纤维支气管镜检查,血流动力学平稳,苏醒快速,效果满意。
Objective To compare the clinical effects of laryngeal mask and endotracheal intubation with remifentanil and propofol in the diagnosis and treatment of pediatric bronchoscopy. Methods Forty children with fibrobronchoscopy were randomly divided into laryngeal mask group (group L, n = 20) and endotracheal intubation group (group T, n = 20). Both groups were induced and maintained by intravenous anesthesia with remifentanil and propofol. Intraoperative ECG, heart rate, noninvasive arterial pressure and pulse oxygen saturation were monitored. The heart rate (HR) of pre-anesthesia (T0) fibrobronchoscopy before anesthesia (T1), entrance to glottis (T2), tracheal carina (T3) and 10th minute (T4) , Mean arterial pressure (MAP) and arterial oxygen saturation (SpO2) were measured. The choking, throat, bronchospasm and body movement were observed during operation. The respiratory recovery time, awake time and extubation time were recorded. Anesthetic satisfaction (evaluated by microscopic examination). Results The HR of both groups increased at T1, which was significantly different from T0 (P <0.05). The T group was higher than L group (P <0.05). The MAP in T2 ~ T4, T group was lower than L group, the difference was statistically significant (P <0.05). There was no cough, throat, bronchospasm or body movement during the microscopic examination in both groups. The resuscitation time, awake time and extubation time of L group were shorter than that of T group, the difference was statistically significant (P <0.05). Conclusions Laryngeal mask-remifentanil combined with propofol anesthesia for pediatric bronchoscopy, hemodynamic stability, rapid recovery, the effect is satisfactory.