CAJ | 학술논문

目的比较置入食管引流型喉罩(PLMA)与经典喉罩(CLMA)对小儿伤害性刺激的程度.方法择期全麻手术患儿47例,性别不限,年龄3-12岁,体重11-36 kg,ASA分级Ⅰ或Ⅱ级,采用随机数字表法,将患儿随机分为PLMA组(n=23)和CLMA组(n=24).采用序贯法进行试验,靶控输注异丙酚行麻醉诱导,待效应室浓度与预设的血浆靶浓度平衡后置入喉罩.PLMA组和CLMA组首例患儿异丙酚血浆靶浓度分别设为6.0和4.4 μg/ml,存在喉罩置入反应,则下一例患儿异丙酚血浆靶浓度升高1个浓度梯度,无喉罩置入反应,则下一例患儿异丙酚血浆靶浓度降低1个浓度梯度,浓度梯度为0.2 μg/ml.喉罩置入反应的标准为:下颌松弛困难无法置入、置入即刻、置往后1 min内出现呛咳、吞咽、肢体运动、屏气或喉痉挛.计算异丙酚抑制喉罩置往反应的半数有效血浆靶浓度及其95％置信区间.结果异丙酚抑制小儿PLMA和CLMA置入反应的半数有效血浆靶浓度及其95％置信区间分别为5.87(5.62～ 6.11)和4.53(4.38 ～ 4.69)μg/ml,差异有统计学意义(P＜0.01).结论置入PLMA对3～12岁小儿的伤害性刺激程度较CLMA增强.
목적 비교치입식관인류형후조(PLMA)여경전후조(CLMA)대소인상해성자격적정도.방법 택기전마수술환인47례,성별불한,년령3-12세,체중11-36 kg,ASA분급Ⅰ혹Ⅱ급,채용수궤수자표법,장환인수궤분위PLMA조(n=23)화CLMA조(n=24).채용서관법진행시험,파공수주이병분행마취유도,대효응실농도여예설적혈장파농도평형후치입후조.PLMA조화CLMA조수례환인이병분혈장파농도분별설위6.0화4.4 μg/ml,존재후조치입반응,칙하일례환인이병분혈장파농도승고1개농도제도,무후조치입반응,칙하일례환인이병분혈장파농도강저1개농도제도,농도제도위0.2 μg/ml.후조치입반응적표준위:하합송이곤난무법치입、치입즉각、치왕후1 min내출현창해、탄인、지체운동、병기혹후경련.계산이병분억제후조치왕반응적반수유효혈장파농도급기95％치신구간.결과 이병분억제소인PLMA화CLMA치입반응적반수유효혈장파농도급기95％치신구간분별위5.87(5.62～ 6.11)화4.53(4.38 ～ 4.69)μg/ml,차이유통계학의의(P＜0.01).결론 치입PLMA대3～12세소인적상해성자격정도교CLMA증강.
Objective To compare the noxious stimulations induced by insertion of Proseai laryngeal mask airway(PLMA)and classic laryngeal mask airway(CLMA)in children.Methods Forty-seven ASA Ⅰ or Ⅱ children,aged 3-12 yr and undergoing surgery under general anesthesia,were randomly divided into 2 groups:PLMA group(group P,n =23)and CLMA group(group C,n =24).General anesthesia was induced with target-controlled infusion(TCI)of propofol.When the effect-site concentration of propofol was equal to the plasma concentration predetermined.PLMA or CLMA insertion was attempted.The target plasma concentration of propofol was predetermined according to Dixon's up-down method,with 0.2 μg/ml as a step size.The initial target plasma concentration of propofol was 6 μg/ml and 4.4 μg/ml for groups P and C,respectively.The preedetermined target plasma concentration of propofol and the satisfaction of insertion conditions for each child were recorded.Results The 50％ effective concentration(EC50)of propofol to achieve satisfied condition of PLMA and CLMA insertion were 5.87(95％ CI,5.62-6.11)and 4.53(95％ C1,4.38-4.69)μg/nl,respectively,and the difference was significant(P ＜ 0.01).Conclusion The noxious stimulation induced by insertion of PLMA in children aged 3-12 years is stronger than that of CLMA.