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托下颌和斜方肌挤压试验用于判定婴幼儿喉罩置入麻醉深度的比较

Comparison of jaw thrust and trapezius squeezing test as indicators for laryngeal mask airway insertion in infants and young children

摘要:

目的 比较托下颌和斜方肌挤压试验用于判断七氟烷吸入麻醉诱导婴幼儿喉罩置入所需麻醉深度的效果.方法 选择2015年1至6月天津市儿童医院行全麻手术的6个月~3岁患儿100例,经美国麻醉医师学会(ASA)病情分级为Ⅰ~Ⅱ级.随机将患儿分为托下颌组(J组,n=50)和斜方肌挤压组(T组,n =50).对患儿施行七氟烷麻醉诱导,并分别间断采用托下颌和斜方肌挤压试验对两组患儿的麻醉深度进行判定:若试验后出现躯体、四肢或足趾运动,为试验反应阳性,可认为麻醉深度不够,需继续吸入七氟烷,直至试验后全身无运动出现,即为实验反应阴性,此时可认为麻醉深度足够,置入喉罩.观察并记录两组患儿试验反应阴性时所需麻醉时间、呼气末七氟烷浓度、Narcotrend麻醉深度监测(NT)指数及喉罩置入后有无身体运动、咳嗽、恶心、憋气、喉痉挛及脉搏氧饱和度(SpO2) <90%等情况,对置入喉罩条件和成功率进行评估,记录喉罩置入前后两组患儿的心率、血压及SpO2.结果 J组与T组患儿试验反应阴性所需的时间分别为(2.31±1.03)、(2.85±0.97)min,呼气末七氟烷浓度分别为(3.25±1.02)%和(3.81±0.87)%,NT指数分别为(50.41 ±5.38)和(41.32±4.92),差异均有统计学意义(t=-2.462、-2.361、3.021,均P<0.05);喉罩一次成功置入率分别78%和100%,差异有统计学意义(x2=12.36,P <0.01).喉罩置入条件构成比T组优于J组.J组患儿出现体动(20%)、咳嗽(16%)、恶心(10%)、屏气(14%)及SpO2 <90% (8%)等不良反应明显多于T组(分别为2%、2%、0、2%及0),差异均有统计学意义(x2=8.27、5.98、5.26、4.89、4.17,均P<0.05).成功置入喉罩的两组患儿,喉罩置入前后的心率、血压及SpO2无明显变化.结论 与托下颌法相比,斜方肌挤压试验是用于判断婴幼儿喉罩置入所需吸入麻醉深度的一种更加安全、可靠的方法.

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abstracts:

Objective To compare the effectiveness of the jaw thrust and the trapezius squeezing test(TST) for laryngeal mask airway (LMA) insertion in infants and children under sevoflurane anesthesia.Methods A total of 100 children aged from 6 month to 3 years,American Society of Anesthesiologists(ASA) Ⅰ-Ⅱ and undergoing minor operation were enrolled from January to June 2015 in Tianjin Children's Hospital.The patients were randomly divided into jaw thrusting group (Group J,n =50) and trapezius squeezing group(Group T,n =50).Anesthesia was induced with sevoflurane.When children's eyelash reflex lose,jaw thrust/trapezius squeeze was applied every 15 seconds.It's considered that the depth of anesthesia was not enough,and test reaction was positive if any movements of body,limbs or toes were found at the point of test.Sevoflurane should be keep on inhalation until negative test reaction was appeared.Then LMA was inserted immediately.The time required for the negative test,end-tidal sevoflurane concentrations (ETsev),the index of Narcotrend anesthesia monitor(NT),the occurrence of gross purposeful movements,coughing,gagging,breath-holding,laryngospasm or an SpO2 < 90% during LMA insertion in two groups of patients were observed and recorded.The condition of LMA insertion and the rate of successful insertion were evaluated.The blood pressure(BP),heart rate(HR) and SpO2 were also recorded before and after LMA insertion.Results In group J and group T,the time required for the negative test was (2.31 ±1.03) vs (2.85 ±0.97)min(t =-2.462,P <0.05),ETsev was(3.25 ±1.02)% vs (3.81 ±0.87) % (t =-2.361,P <0.05),the depth of anesthesia NT index was(50.41 ±5.38) vs (41.32 ±4.92) (t =3.021,all P < 0.05).All of above results were significantly different.The successful rate of the first attempt LMA insertion was 78% vs 100% (x2 =12.36,P < 0.01),respectively.The differences had statistical significance.The conditions of LMA insertion in group T were superior to those in group J.The incidences of gross purposeful movements,coughing,gagging,breath-holding and SpO2 < 90% during LMA insertion in group J were 20%,16%,10%,14% and 8%,which were higher than those in group T (2%,2%,0,2%,0),the differences were significant(x2 =8.27,5.98,5.26,4.89,4.17,all P < 0.05).No significant change in blood pressure,heart rate and SpO2 were found before and after inserting LMA in two groups.Conclusion The trapezius squeezing test is a superior indicator of adequate condition for LMA insertion compared to the jaw thrust in infants and young children under sevoflurane anesthesia.

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作者: 刘金柱 [1] 赵娟 [1] 章艳君 [1]
作者单位: 300134,天津医科大学临床儿科学院天津市儿童医院麻醉科 [1]
期刊: 《中华医学杂志》2016年96卷6期 451-455页 MEDLINEISTICPKUCSCD
栏目名称: 临床研究
DOI: 10.3760/cma.j.issn.0376-2491.2016.06.009
发布时间: 2016-03-14
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