喉罩和气管导管在小儿眼科手术中对眼压影响的比较

Comparison of effect on intraocular pressure with laryngeal mask airway and endotracheal tube for ophthalmic surgery in paediatric patients

摘要:

目的：探讨喉罩(LMA)麻醉与气管插管麻醉应用于小儿眼科手术的安全性以及对眼压波动的影响。

方法：小儿眼科手术患者90例，按照入院随机数字表随机分为喉罩组(L组)和气管导管组(T组)，每组45例。观察记录两组麻醉诱导前(T₀)、建立气道即刻(T₁)、建立气道后3min(T₂)、拔管后即刻(T₃)、拔管后3min(T₄)的SBP，DBP，HR及眼内压(IOP)的变化，并记录两组患者拔管时间、术中术后相关并发症发生情况。

结果：T组T₁，T₂，T₃，T₄时SBP，HR均高于T₀及L组(P<0.05)。L组T₁，T₂，T₃，T₄时SBP，HR较T₀时略有升高，但无统计学意义(P>0.05)。T 组T₁，T₂，T₃，T₄时IOP较T₀，L组明显增高(P<0.05)，L组T₁，T₃时IOP略有升高，但各时点IOP差异无统计学意义。T组拔管时间较L组明显延长且较多术后并发症(P<0.05)。

结论：与气管导管相比，喉罩通气在诱导及麻醉过程中血流动力学稳定，气道损伤少、眼内压波动幅度小，围手术期并发症少，术后恢复快，适用于小儿眼科手术。

Abstract:

AIM: To evaluate efficacy and safety of laryngeal mask anesthesia(LMA)and endotracheal intubation anesthesia and effect on intraocular lens(IOP)for paediatric ophthalmic surgery.

METHODS: Totally 90 patients under general anesthesia in paediatric ophthalmic surgery were equally randomly divided into LMA group(group L)and endotracheal intubation group(group T). Before induction of anesthesia(T₀), immediately after insert LMA / endotracheal tube(T₁), 3 minutes after insert LMA / endotracheal tube(T₂), immediately after extubation(T₃), 3 minutes after extubation(T₄), the systemic blood pressure(SBP), diastolic blood pressure(DBP), heart rate(HR)and IOP were recorded. The time of extubation, and the incidence of anesthetic complication were recorded.

RESULTS: SBP, HR, IOP during T₁, T₂, T₃, T₄ were significantly higher in group T than T₀, and those in group L(P<0.05). SBP, HR, IOP were not significantly changed in group L during each time.

CONCLUSION: Compared with endotracheal intubation, LMA is an effective, safety anesthesia for ophthalmic surgery in children, with the advantages of hemodynamic stability, mild airway trauma, maintain IOP stability, fewer perioperative complications and anesthesia revive fast.