CAJ | 학술논문

目的比较可弯曲喉罩(FLMA)与气管导管(ETT)在儿童腺样体扁桃体切除术中应用的可行性和安全性。方法选择静吸复合全身麻醉下择期行小儿鼾症腺样体扁桃体切除手术的患儿40例,随机均分为FLMA组和ETT组。麻醉诱导后分别置入FLMA/ETT。记录诱导前(T0)、置入后1(T1)、3(T2)、5 min (T3)、拔出后1(T4)、3 min (T5)的心率(HR)、脉搏氧饱和度(SpO2)、平均动脉压(MAP)；记录置入FLMA/ETT后5 min( T6),置入开口器后10( T7)、20 min (T8),移除开口器后5 min(T9)的呼吸动力学指标：气道峰压( Ppeak )、平均气道压( Pmean )、呼末二氧化碳分压( Pet-CO2),记录1次置入成功率,返流和误吸发生率,拔管时和拔管后呛咳、喉痉挛、喘鸣、躁动的发生情况；观察术后24 h内不良反应发生率。结果ETT组T1、T2、T3、T4、T5时MAP, HR均高于T0及FLMA组(P<0.05)。 FLMA组T1、T2、T3、T4、T5时MAP,HR较T0时略有升高,但差异无统计学意义。Ppeak、Pmean在ETT组高于FLMA组(P<0.05)。 ETT组拔管时间较FLMA组明显延长且较多术后并发症( P <0.05)。结论与传统的 ETT 相比,在不影响外科操作的前提下, FLMA通气体现出诱导及麻醉过程中血流动力学及呼吸动力学平稳,苏醒期血流动力学平稳,无明显呛咳躁动,出血少；气道损伤少,术后咽痛率低,舒适度提高。
목적비교가만곡후조(FLMA)여기관도관(ETT)재인동선양체편도체절제술중응용적가행성화안전성。방법선택정흡복합전신마취하택기행소인한증선양체편도체절제수술적환인40례,수궤균분위FLMA조화ETT조。마취유도후분별치입FLMA/ETT。기록유도전(T0)、치입후1(T1)、3(T2)、5 min (T3)、발출후1(T4)、3 min (T5)적심솔(HR)、맥박양포화도(SpO2)、평균동맥압(MAP)；기록치입FLMA/ETT후5 min( T6),치입개구기후10( T7)、20 min (T8),이제개구기후5 min(T9)적호흡동역학지표：기도봉압( Ppeak )、평균기도압( Pmean )、호말이양화탄분압( Pet-CO2),기록1차치입성공솔,반류화오흡발생솔,발관시화발관후창해、후경련、천명、조동적발생정황；관찰술후24 h내불량반응발생솔。결과ETT조T1、T2、T3、T4、T5시MAP, HR균고우T0급FLMA조(P<0.05)。 FLMA조T1、T2、T3、T4、T5시MAP,HR교T0시략유승고,단차이무통계학의의。Ppeak、Pmean재ETT조고우FLMA조(P<0.05)。 ETT조발관시간교FLMA조명현연장차교다술후병발증( P <0.05)。결론여전통적 ETT 상비,재불영향외과조작적전제하, FLMA통기체현출유도급마취과정중혈류동역학급호흡동역학평은,소성기혈류동역학평은,무명현창해조동,출혈소；기도손상소,술후인통솔저,서괄도제고。
Objective To compare the eficacy and safety of flexible laryngeal mask (FLMA) and endotracheal tube (ETT) in children undergoing adenoidectomy and tonsillectomy. Methods Forty children with snoring disease scheduled for selective adenoidectomy and tonsillectomy surgery under intravenous compound inhalation general an-esthesia were divided randomly into either FLMA group or ETT group. MAP,HR and SpO2 were recorded before an-esthesia induction(T0 ), 1 (T1 ),3 (T2 ),5 (T3 ) min after intubation,1(T4 ),3 (T5 ) min after extubation. Param-eters for respiratory mechanics included peak airway pressure (Ppeak ), mean airway pressure (Pmean ), end tidal CO2 (PetCO2 ),and airway sealing pressure. All of the above indicators were recorded 5 min (T6 ) after intubation, 10 (T7 ),20 (T8 ) min after put in mouth gag,5 (T9 ) min after removing mouth gag. Meanwhile,chievement ratio of first time insertion,incidence of regurgitation aspiration,bucking,laryngospasm,wheezing when extubation and af-ter extubation,anesthesia time,surgery time,extubation time were recorded. Complications such as nausea and vomi-ting,pharyngeal pain,hoarseness were followed up 24 hours after surgery. Results MAP, HR during T1 , T2 , T3 , T4 ,T5 were significantly higher in group T than T0 , and those in group FLMA (P<0.05). MAP, HR were not sig-nificantly changed in group FLMA during each time. Ppeak , Pmean was significantly lower in group FLMA than that in group ETT. The extubation time was shorter and the incidence of coughing and pharyngalgia after operation was low-er in group FLMA than that in group ETT. Conclusion Compared with endotracheal intubation, on the basis of not affecting surgical operation, FLMA is an effective, safe anesthesia for adenoidectomy and tonsillectomy surgery in children, with the advantages of hemodynamic stability, mild airway trauma,and is a easy handling method, with minor laryngeal stimulation during intubation and extubation, more stable hemodynamics, reliable respiratory me-chanics and low incidence of postoperative upper airway complications.