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Igel喉罩和Ambu喉罩用于1岁以下婴儿全身麻醉的比较
A comparison of airway management between laryngeal mask airway-I-gel and laryngeal mask airway-Ambu in infant under one-year-old with general anesthesia.

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DOI:
作者:
顾志清1 刘珺珺1 金泉英1 陈莲华2*
GU Zhi-qing1, LIU Jun-jun1, JIN Quan-ying1, CHEN lian-hua2
作者单位:
1.上海市儿童医院，上海交通大学附属儿童医院麻醉科 2.上海市第一人民医院，上海交通大学附属第一人民医院麻醉科
Department of Anesthesiology, 1Shanghai Children Hospital, 2Shanghai First People’s Hospital, Jiaotong University, Shanghai, China
关键词:
I-gel喉罩；Ambu喉罩；呼吸动力学；婴儿
Laryngeal mask airway-I-gel; Laryngeal mask airway-Ambu; Respiratory mechnics; Infants
摘要:
【摘要】 目的 喉罩通气道因置入方便和对气道刺激小等优点已成为全身麻醉中常用的气道管理工具，但传统喉罩的许多缺点包括上呼吸道梗阻、胃胀气或漏气等,限制了其在1岁以下婴儿中的使用。本文采用连续气道监测手段，比较I-gel喉罩和Ambu喉罩用于1岁以下婴儿全身麻醉气道管理的安全性和适用性。 方法 选择0-1岁择期行泌尿外科手术的患儿30例，采用抽签法随机分为I-gel喉罩组（I组，n=15）和Ambu喉罩组（A组，n=15）。记录喉罩成功置入所需时间、首次置入成功率，喉罩置入成功后的纤维支气管镜评分（Fiber Optic Bronchoscope，FOB）。诱导后(T0)、喉罩置入时(T1)、置入后30分钟内每隔10分钟为一记录点(T2、T3、T4)记录血流动力学数据，同时记录气道密封压（Leakage Pressure, LP）和呼吸动力学数据：吸入/呼出潮气量(VTin/ex)、气道峰压（PIP/Ppeak）、吸气平台压（Pplat）、平均气道压（Pmean）、呼气末正压（PEEP）、呼气峰流速（PEF）、肺顺应性（Compl）和呼末二氧化碳分压（ETCO2）。计算每公斤体重吸入/呼出潮气量(ml/kg)、漏气分数（Leakage fraction，Lf)[(VTin-VTex)/VTin]、呼气阻力(Expiratory Resistance, Re) [(Pplat-PEEP)/PEF]和呼吸功(Work of Breathing,WOB)[(PIP-1/2* Pplat)+VTin]。观察喉罩相关不良反应发生情况。 结果 两组喉罩的置入成功率无显著差异(P>0.05)。与A组相比，I组置管时间明显缩短（P<0.05）。两组喉罩成功置入后的FOB评分无明显差异(P>0.05)。呼吸动力学监测，两组间各个时间点比较:I组的LP和RE均显著高于A组（P<0.05）, I组的PEF显著低于A组(P<0.05)。同一组内各个时间点比较： T1时间点，I组漏气分数显著高于其他时间点(P<0.05)；A组的漏气分数、VT(in/ex)和WOB显著高于其他时间点(P<0.05)。T2时间点，I组和A组的漏气分数显著高于T3、T4时间点(P<0.05)。T4时间点，A组的Compl显著低于T1、T2时间点。其余指标各组各时间点上均无统计学差异(P>0.05)。两组患儿均无低氧血症发生，喉罩取出后均未见返流、误吸和喉、支气管痉挛等不良反应。除I组患儿的胃胀气发生率显著低于A组(5例，33.33%，P<0.05)外，其余不良反应的发生率在两组间无显著差异。 结论 I-gel喉罩和Ambu喉罩均能满足1岁以内婴儿全身麻醉机械通气的通气效果，但I-gel喉罩置入时间更短，气道密封性更优，胃胀气及其他不良反应的发生率更低，更有利于麻醉医师对气道进行控制和管理。
【Abstract】 Objective Laryngeal mask airway (LMA) has been widely used in general anesthesia for the advantages of easier insertion and milder cardiovascular response to insertion. Meanwhile, some drawbacks limit the application of LMA in infants, such as upper airway semi-obstruction, air leakage and gastric air insufflations. The study was designed to compare the efficacies of the LMA-I-gel and the LMA-Ambu in infant under one-year-old during general anesthesia by using continuous airway monitoring technique. Methods thirty infant, ASA I, aged 0 to 1 year, undergoing urologic surgical procedures were randomly divided into two groups. LMA-I-gel and LMA-Ambu were inserted in group I and A (n=30 in each), respectively. Achievement ratio of first time insertion, inserting time, airway leakage pressure (LP), classification after bronchoscope of Fiber Optic Bronchoscope (FOB), incidence of gastric insufflations, quality of airway and respiratory complications were recorded. Parameters for respiratory mechanics including tidal volume (VTin/ex), peak inspiratory pressure (PIP), plateau airway pressure (Pplat), mean airway pressure (Pmean), positive end expiratory pressure(PEEP),peak expiratory flow(PEF),pulmonary compliance(Compl),end tidal CO2(ETCO2), were recorded 0, 10, 20, 30min after intubation．Meanwhile, HR、BP、SpO2 were monitored. Tidal volume(VTin/ex) per kilogram of body weight, leakage fraction(Lf),expiratory resistance(Re) and work of breathing (WOB) were calculated. Results there were no differences in achievement ratio of first time insertion and classification of FOB among the two groups respectively(P>0.05). Compared with group A, inserting time was shorter (P<0.05), LP and Re were higher (P<0.05), and PEF was lower (P<0.05) in group I. Meanwhile, at each time point in each group, fraction of leakage in both groups were higher in 0 and 10min than that in the other time points (P<0.05). VT(in/ex) and WOB in group A in 0 min was higher than those in the other time points (P<0.05). In 30 min, Compl in group A was lower than that in the other time points (P<0.05). There were no significant differences in the complications in both groups (P>0.05), except the incidence of gastrectasia was higher in group A (P<0.05). Conclusion Both LMA-I-gel and LMA-Ambu can be used for effective airway management in infant under one-year-old during general anesthesia. Moreover, LMA-I-gel presents shorter insertion time, better airway sealing, less gastric flatulence and other complications, which should be more convenient for the airway management in infants.

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