目的评价喉罩或单腔气管内插管在胸腔镜下胸交感神经链切断术的应用效果。 方法选择80例行胸腔镜下胸交感神经链切断术的手汗症患者，采用计算机随机法将患者分为A、B两组，每组各40例。其中A组男20例、女20例，平均年龄24岁；B组男21例、女19例，平均年龄23岁。A组使用喉罩通气，B组使用单腔气管内导管，均应用小潮气量较快频率正压通气及间歇人工气胸。观察两组麻醉期间各时点心率（HR）、平均动脉压（MAP）、呼气末二氧化碳分压（PetCO2）、动脉血氧饱和度（SpO2）、心电图（ECG）的变化。同时记录喉罩/单腔导管置入时间、CO2充气时间、手术时间、术中术后不良反应和并发症。 结果两组患者手术顺利，无并发症。A组喉罩/插管置入时间和喉罩/单腔管呛咳、术后咽喉疼痛发生率低于B组，差异有统计学意义（P<0.05）。B组MAP、HR水平在T2（喉罩/单腔管置入后）和T7（苏醒后拨喉罩/单腔管时）明显高于T1（麻醉诱导完成），差异有统计学意义（P<0.05）；A组MAP、HR水平在T2和T7时亦明显低于B组，差异有统计学意义（P<0.05）。所有患者术中ECG、SpO2和PetCO2无明显变化。 结论喉罩或单腔气管内插管结合间歇的人工气胸都能满足胸交感神经切断术的操作需要，喉罩具有更稳定的血流动力学状态和更高的安全性。
Objective To systematically assess the effectiveness and safety of ProSeal laryngeal mask (PLMA) compared to endotracheal tube (TT) for airway management in the patients undergoing laparoscopic biliary tract surgery.Methods Using the Cochrane systematic review methods, we searched the Cochrane Controlled Trial Registers (CCTR) of The Cochrane Library, MEDLINE, VIP, and CNKI databases through May 2008. We also handsearched relevant journals and conference proceedings. Two reviewers independently selected studies and assessed the quality of the trials. Disagreements were resolved by discussion, in consultation with a third reviewer. RevMan 4.2 software provided by the Cochrane Collaboration was used for meta-analysis which was performed for combining the results of homogeneitystudies. Results Seven studies involving 493 patients undergoing laparoscopic biliary tract surgery were included. Meta analysis results showed that: ① Side effects: none of the patients experienced regurgitation or hypoventilation. ② PLMA was superior to TT in terms of less postoperative sore throat (OR=0.27, 95%CI 0.13 to 0.53, P=0.0002) and response during extubation (OR=0.01, 95%CI 0.00 to 0.03, Plt;0.00001). ③ PLMA was similar to TT in terms of effective ventilation during peritoneal insufflation (Ppeak: WMD=0.01, 95%CI -0.66 to 0.68, P=0.98; PetCO2: WMD=0.01, 95%CI -0.58 to 0.59, P=0.99) and ease of insertion (OR=0.58, 95%CI 0.23 to 1.47, P=0.25). ④ Hemodymatics changed during the procedure: PLMA was more stable than TT. Conclusion It is safe to use PLMA for ventilation in laparoscopic biliary tract surgery. However, up to now, we still cannot draw a definite conclusion due to the low quality of the included studies, and more high quality trials of PLMA airway management for laporoscopic surgery are needed.
摘要:目的:评价II代引流型喉管(LTS II)和Proseal喉罩(PLMA)在择期手术中应用效果。方法:检索了Cochrane图书馆(2009年第3期)、Pubmed(1950～2009)、EMBase(1989～2009)、CNKI(1979～2009)、VIP(1989～2009)、CBM(1978～2009)中相关II代引流型喉管(LTS II)和Proseal喉罩在择期手术中应用的随机对照试验(RCT),同时筛检纳入文献的参考文献。由2名研究者对文献质量进行严格评价和资料提取,根据指标相应异质性进行描述性分析或Meta分析(RevMan 5.0)。结果:共纳入3个RCT,共244例研究对象,文献质量均为B级。3个RCT的结果显示与PLMA相比,LTS II具有相似的首次置入成功率(P=0.45)、术毕即刻上呼吸道损伤发生率(P=1.00)、术后24 h咽痛发生率(P=0.81)、术后24 h吞咽困难发生率(P=0.12)。2个RCT的结果显示两组引流管置入均较容易。1个RCT的结果显示两组的操作者主观评价相近(OR=1.86,95%CI 0.39～ 8.99)。气道封闭效果由于采用方法学差异性较大,指标也不尽相同,尚不能得出准确结果。结论:LTS II在择期手术中用于气道管理具有较好的前景。但是现时仍不宜用于需在择期术中进行控制通气的病人。关于气道封闭效果,尚需采用更合理规范的指标、更高质量的研究设计进一步研究。Abstract: Objective: To assess the efficacy of laryngeal tube suction II (LTS II) and LMAProseal (PLMA) for airway management in elective surgery. Methods:We searched Cochrane Library (2009),Pubmed (19502009)、EMBase (19892009),CNKI (19792009),VIP (19892009),CBM (19782009). 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.
Objective To systematically assess the effectiveness and safety of streamlined liner of the pharynx airway (SLIPA) compared with endotracheal tube (TT) for airway management in patients undergoing laparoscopic cholecystectomy surgery. Methods Databases such as PubMed (1992 to February 2012), EMbase (1984 to February 2012), MEDLINE (Ovid, 1964 to February 2012), SCI (1992 to February 2012), CNKI (1992 to February 2012), CBM (2002 to 2012) as well as WanFang Data (1992 to February 2012) were searched for relevant literature. The references of the included articles were also manually traced. Two reviewers independently screened the trials according to inclusion and exclusion criteria, extracted the data, and assessed the quality of methodology. Meta-analyses were performed using RevMan 5.0 software. Results Ten randomized controlled trials (RCTs) involving 664 patients were included. Results of meta-analysis showed that: a) as for side effects, none of the patients experienced regurgitation or hypoventilation during operation; b) as for extubation response, SLIPA was proved fewer than TT during extubation with a significant difference (RR=0.14, 95%CI 0.05 to 0.36, Plt;0.000 1); c) SLIPA was superior to TT with regard to reducing postoperative sore throat (RR=0.15, 95%CI 0.06 to 0.38, Plt;0.000 1); d) SLIPA was similar to TT with regard to Ppeak after peritoneal insufflations (WMD=–0.07, 95%CI –0.73 to 0.59, P=0.83); e) as for PETCO2, the SLIPA group was lower than the TT group obviously after peritoneal insufflations (WMD=–1.09, 95%CI –1.70 to –0.49, P=0.000 4); f) as for hemodynamic change, the SLIPA group was more stable than the TT group during the operation with significant differences (Plt;0.05). Conclusion Current studies suggest that it is safe and effective to apply SLIPA for ventilation in laparoscopic cholecystectomy surgery. However, due to the limited quantity and quality of the included studies, more high-quality studies are need.
目的:观察经喉罩全凭七氟醚吸入麻醉在小儿腹股沟疝手术中的临床应用效果。方法：60例ASAⅠⅡ级择期行腹股沟疝囊高位结扎术的患儿随机分成喉罩七氟醚组（实验组）和氯胺酮组（对照组）。实验组以七氟醚诱导后置入喉罩，经喉罩全凭七氟醚吸入维持麻醉，对照组以氯胺酮和异丙酚诱导和维持麻醉。比较两组血流动力学、呼气末CO2分压（PETCO2）、手术时间、苏醒时间、出室时间（在恢复室内停留时间）。记录术中和术后不良反应如体动反应、嗜睡、恶心呕吐等发生情况。结果：对照组在T3、T4、T5时点HR、BP均明显高于实验组相应时点（Plt;0.05）。实验组患儿苏醒时间和出室时间均明显低于对照组（Plt;0.05）。对照组体动反应和嗜睡发生率明显高于实验组（Plt;0.05）。实验组术后恶心发生率明显高于对照组（Plt;0.05）。结论：经喉罩全凭七氟醚吸入麻醉用于小儿腹股沟疝手术，术中经过更平稳，麻醉恢复更快，术中及术后不良反应少。
【摘要】 目的 比较喉罩和气管内插管吸入七氟烷全麻用于小儿无痛苦纤支镜检查的麻醉效果、苏醒时间、苏醒质量。 方法 将2008年3月-2009年3月40例行纤支镜检查的患儿随机分为喉罩组（L组，21例）和气管内插管组（T组，19例）。两组均采用逐渐诱导法吸入七氟烷，静脉给予芬太尼1 μg/kg；L组置入喉罩，T组气管插管后控制呼吸。手术中，两组均吸入2%～5%七氟烷维持麻醉。分别记录麻醉前（T0）、麻醉后纤支镜进入前（T1）、进镜至咽部（T2）、声门部（T3）、气管内（T4）及第15 min（T5）时的血压（BP）、心率（HR）、MAP和动脉血氧饱和度（SPO2）。观察纤支镜检查期间有无呛咳、气道痉挛或体动；记录停药至拔管的时间，苏醒后是否再入睡及麻醉满意度。 结果 两组HR在T1、T3、T4时升高，与T0时比较，有统计学意义（Plt;0.05）；其中HR在T1时T组高于L组，组间比较有统计学意义（Plt;0.05）；MAP在T1、T2、T3、T4时，T组低于L组，组间比较有统计学意义（Plt;0.05）。两组患儿镜检期间均无呛咳、气道痉挛或体动；L组苏醒时间短于T组（Plt;0.05），苏醒后再入睡率低于T组（Plt;0.05），麻醉满意度高于T组（Plt;0.05）。 结论 喉罩吸入七氟烷全麻用于小儿无痛苦纤支镜检查，能保证稳定的血流动力学状态，苏醒快速，效果满意。【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.
【摘要】 目的 比较喉罩全麻与气管插管全麻两种麻醉方法在小儿侧卧位短小手术中的优缺点。 方法 2009年6月-2010年2月，将40例择期行侧卧位短小手术儿患，随机分为喉罩全麻（L）组与气管插管全麻（T）组，每组各20例。观察患儿术中心率（HR）、平均动脉压（MAP）、脉搏血氧饱和度（SpO2）、气道峰压（Pmax），恶心呕吐、术后躁动等围术期不良反应。 结果 T组插管后及拔管后即刻HR、MAP均高于L组患儿（Plt;0.05）；SpO2、Pmax在两组之间比较差异无统计学意义（Pgt;0.05），T组患儿术后躁动发生率明显高于L组（Plt;0.05）。 结论 喉罩可以安全、有效地用于小儿侧卧位短小手术麻醉，且操作简便，插管期和拔管期心血管应激反应轻，术后躁动发生率低。【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.
【摘要】 目的 观察依托咪酯乳剂复合舒芬太尼用于全麻下喉罩置入的血流动力学变化。 方法 选择2009年4月-2010年2月间，46例需全麻手术、适合使用喉罩，美国麻醉医师协会（ASA）Ⅰ～Ⅱ级，年龄18～60岁的患者，随机分为两组:依托咪酯乳剂组（E组）23 例，静脉推注咪达唑仑0.05 mg/kg，依托咪酯乳剂0.3 mg/kg；依托咪酯乳剂+舒芬太尼组（ES组）23 例，静脉推注咪达唑仑0.05 mg/kg，依托咪酯乳剂0.15 mg/kg，加舒芬太尼0.5 mg/kg，诱导后置入喉罩，记录患者诱导前、用药后1 min、喉罩置入后1 min的心率（HR）、平均动脉压（MAP）以及评估喉罩置入条件的6项指标（张口困难分级、置入喉罩困难分级、舌咽反射、干咳干呕反射、肢动反应及喉痉挛分级），同时记录呼吸暂停时间。 结果 ES组能提供更好的喉罩置入条件，且能减少舌咽反射和肢体反应， 更能保证喉罩置入时血流动力学的稳定。 结论 依托咪酯乳剂复合舒芬太尼能为全麻喉罩置入时提供更好的条件，且能保证更好的血流动力学稳定。【Abstract】 Objective To investigate the hemodynamics changes when etomidate combined with sufentanil was applied for laryngeal mask airway insertion under the general anaesthesia. Methods From April 2009 to February 2010, 46 patients requiring general anesthesia using laryngeal mask airway (LMA) (American Society of Anesthesiologists (ASA)Ⅰ-Ⅱ) aged 18-60 were randomly divided into two groups: 23 in etomidate emulsion group (group E) underwent the intravenous injection with midazolm (0.3 mg/kg) and etomidate (0.05 mg/kg); 23 in etomidate emulsion + sufentanil group (group ES) underwent the intravenous injection with etomidate (0.15 mg/kg), midazolm (0.05 mg/kg), and sufentanil 0.5 mg/kg. The patients were evaluated by six indexes of LMA insertion (mouth opening, swallowing reflex, cough reflex,vomiting reflex, body motion, and laryngospasm classification). After the anesthesia induction, LMA was inserted. The blood pressure (BP), heart rate (HR), and mean arterial pressure (MAP) were recorded before anesthesia induction one minute after the injection and one minute after LMA insertion. Meanwhile, the apnea time was recorded. Results Compared with group E, group ES offered better anesthesia for LMA insertion, less swallowing reflex and body motion, and more stable haemodynamics. Conclusion Etomidate combined with sufentanil provides good condition for LMA insertion under the general anaesthesia with steady haemodynamics.