不同类型喉罩在儿童纤维支气管镜检查中的应用比较

Comparison of effectiveness of I-gel and Air-Q on children's painless fiberoptic bronchoscopy examination

摘要:

目的研究比较I-gel喉罩与充气型Air-Q喉罩在小儿无痛纤维支气管镜检查中的应用效果。方法100例全身麻醉下行纤维支气管镜检查的患儿,按随机数字法均分为I-gel喉罩组(I组)与Air-Q喉罩组(A组)。入室后快速麻醉诱导,待患儿下颌松弛后,I组插入I-gel喉罩,A组插入Air-Q喉罩,喉罩置入到位后,行纤维支气管镜检查。记录患儿麻醉诱导前(T₀)、置入喉罩后即刻(T₁)、拔出喉罩时即刻(T₂)的平均动脉压(MAP)与心率(HR);观察记录每例患儿喉罩置入时间、置入次数、纤支镜下下直视所见声门和会厌的情况;记录术中喉罩移位情况与操作者满意度及术后咽喉痛和声音嘶哑发生情况。结果100例患者全部完成喉罩置入及纤维支气管镜检查,两组患儿T₀、T₁、T₂的MAP、HR差异无统计学意义(P>0.05);I-gel组和Air-Q组的喉罩置入时间分别为(9.61±3.52)s和(17.33±9.36)s,I组少于A组(P<0.05);而在置入纤支镜后声门显露程度、纤支镜操作时间差异无统计学意义(P>0.05);I组在操作过程中喉罩置入成功次数少于A组(P<0.05);I组在操作过程中喉罩调整次数少于A组(P<0.05);两组操作者满意度比较差异无统计学意义(P>0.05);I组患儿术后咽喉疼痛情况优于A组(P<0.05)。结论I-gel和Air-Q均可为儿童纤支镜检查创造良好的操作条件,但I-gel喉罩的置入更加方便,操作过程中的移位发生得更少,术中调整次数较少并且术后咽喉部疼痛的发生率更低,更适合用于儿童纤支镜检查。

Abstract:

【Objective】To compare the effect of the I-gel and the Air-Q on children's painless fiberoptic bronchoscopy examination.【Methods】A total of 100 children undergoing fiberoptic bronchoscopy under general anesthesia were randomly divided into the I-gel laryngeal mask group(group I)and the Air-Q laryngeal mask group(group A).After rapid induction of anesthesia until the jaw was relaxed,the I-gel was inserted in group I,and the Air-Q was inserted in group A.After the laryngeal mask was put in place,fiberoptic bronchoscopy was performed.The mean arterial pressure(MAP)and heart rate(HR)before anesthesia induction(T₀),after laryngeal mask placement(T₁),and after laryngeal mask removal(T₂)were recorded.The time and times of laryngeal mask insertion,the glottis and epiglottis seen directly under the bronchoscope in each case was observed and recorded.Intraoperative laryngeal mask displacement,operator satisfaction,postoperative sore throat and hoarseness were recorded.【Results】All 100 patients completed laryngeal mask implantation and fiberoptic bronchoscopy.There were no statistically significant differences in MAP and HR between the two groups before anesthesia induction(T₀),immediately after laryngeal mask implantation(T₁),and immediately after laryngeal mask extraction(T₂)(P>0.05).The insertion time of laryngeal mask in the I-gel group and the Air-Q group was 9.61±3.52 s and 17.33±9.36 s,respectively,and the difference was statistically significant(P<0.05),while the difference was not statistically significant in the glottis exposure after fiberoptic bronchoscope implantation and operation time of fiberoptic bronchoscope(P>0.05).The number of successful implantation in group I was less than that in group A(P<0.05).The number of laryngeal mask adjustments in group I was less than that in group A(P<0.05).There was no significant difference in operator satisfaction between the two groups(P>0.05).The postoperative sore throat was better in group I than in group A,and the difference was statistically significant(P<0.05).【Conclusion】Both I-gel and Air-Q can create good operating conditions for bronchoscopy in children.However,the placement of the I-gel is more convenient,less displacement occurs during the operation,less intraoperative adjustment times and less incidence of postoperative laryngeal pain,so it is more suitable for children's fibrobronchoscopy.