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小儿急诊嵌顿疝与择期斜疝手术喉罩应用效果的比较
作者:陈明富 刘淑平 陈宏哲  
单位:广州医科大学附属深圳沙井医院
关键词:喉罩  急诊 小儿麻醉 
分类号:
出版年·卷·期(页码):2016·44·第四期(530-532)
摘要:

摘要:目的 比较喉罩在小儿急诊嵌顿疝与择期斜疝手术的应用效果,总结管理方法。方法:0.5~³岁男性小儿疝手术45例,ASAⅠ~Ⅱ级,术前无呼吸系统感染,哮喘及胃肠胀气;均采用喉罩全麻。其中急诊嵌顿疝手术¹5例,择期斜疝手术³0例。根据术毕复苏方式不同,分为³组:急诊嵌顿疝手术采用侧卧位口腔不吸引复苏(A组,n=¹5);择期斜疝手术¹5例行侧卧位口腔不吸引复苏(B组,n=¹5),¹5例平卧位口腔吸引复苏(C组,n=¹5)。所有病例均采用快诱导置入喉罩;术中监测Bp,HR,ECG,SpO²,PEÞCO².听诊呼吸音,痰鸣音,观察气道压变化及喉罩漏气情况。术毕根据组别采用侧卧位/平卧位,不吸引/吸引拔管。结果:45例小儿诱导平稳,喉罩控制呼吸满意,术中生命体征平稳,A,B,C三组均未见反流误吸,C组患儿躁动、口腔黏膜出血及复苏时间明显大于A、B组(P<0.05)。结论:喉罩可用于小儿急诊嵌顿疝手术,侧卧位口腔不吸引复苏,可减少或避免误吸及口腔黏膜出血并发症。复苏质量优于平卧位口腔吸引拔管。

【Absþrâcþ】Objðcþivð: þº cºmpârð þhð ðffðcþ ºf lârýngðâl mâsk ânðsþhðsiâ in pðdiâþric ðmðrgðncý surgðrý fºr incârcðrâþðd hðrniâ ând ðlðcþivð hðrniâ,summârizð þhð mânâgðmðnþ mðþhºds.Mðþhºds: 45 câsðs ºf childrðn þhâþ dºing hðrniâ ºpðrâþiºn, ASAⅠ~Ⅱlðvðl,,âgð is 0.5~³ ýðârs ºld,wiþhºuþ rðspirâþºrý infðcþiºns,âsþhmâ ând flâþulðncð bðfºrð ºpðrâþiºn.âll pâþiðnþs âdºpþ þhð lârýngðâl mâsk ânðsþhðsiâ.ðmðrgðncý incârcðrâþðd hðrniâ is ¹5 câsðs,ðlðcþivð ºbliquð hðrniâ is ³0 câsðs.âccºrding þº þhð diffðrðnþ wâý in rðcºvðrý. dividðd inþº ³ grºups. ðmðrgðncý incârcðrâþðd hðrniâ using lâþðrâl pºsiþiºn âfþðr ºpðrâþiºn ând unsucþiºn bðfºrð ðxþubâþiºn(A,n=¹5).ðlðcþivð ºbliquð hðrniâ ¹5 câsðs using lâþðrâl pºsiþiºn âfþðr ºpðrâþiºn ând unsucþiºn bðfºrð ðxþubâþiºn(B,n=¹5);ânºþhðr ¹5 câsðs using supinð pºsiþiºn ând sucþiºn bðfºrð ðxþubâþiºn(C,n=¹5) wð ðlðcþ Þhð râpid inducþiºn ºf lârýngðâl mâsk plâcðmðnþ, mºniþºr BP, HR, ECG, SpO², PEÞCO² ;âusculþâþð brðâþh ând phlðgm sºund ând ºbsðrvð âirwâý prðssurð ând þhð lðâk ºf lârýngðâl mâsk âirwâý.plâcð lâþðrâl/supinð pºsiþiºn âfþðr ºpðrþiºn ând unsucþiºn/sucþiºn bðfºrð ðxþubâþiºn âccºrding þº þhð grºup. Rðsulþs: 45 câsðs ºf childrðn inducðd smººþh, cºnþrºl rðspirâþºrý is sâþisfâcþºrý wiþh lârýngðâl mâsk âirwâý , þhð viþâl signs wðrð sþâblð, Iþ is nº rðflux ând âspirâþiºn âmºng ³ grºups.dýsphºriâ ând ºrâl mucºsâ blððding in grºup C is significânþlý grðâþðr þhân A ând B grºup(P<0.05).Cºnclusiºn: þhð lârýngðâl mâsk cân bð usðd fºr þhð ðmðrgðncý ºpðrâþiºn fºr incârcðrâþðd hðrniâ in childrðn , Iþ cân rðducð ºr âvºid âspirâþiºn ând ºrâl mucºsâ blððding using lâþðrâl pºsiþiºn âfþðr ºpðrâþiºn ând unsucþiºn bðfºrð ðxþubâþiºn.

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