The Clinical Experience of Laryngeal Mask Airway in Neonates Undergoing General Anesthesia
李成文  薛富善 
佟世义  廖  旭 
张雁鸣  孙海涛 
刘鲲鹏
中国医学科学院中国协和医科大学整形外科医院麻醉科
北京100041
Chengwen Li, Fushan Xue, Shiyi Tong, Xu Liao, Haitao Sun, Kunpeng Liu
Department of Anesthesiology，Plastic Surgery Hospital，Chinese Academy of Medical Sciences and Peking Union Medical college，Beijing 100041.
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                                            　　　　 ABSTRACT
　Objectives:To summarize the Clinical experience of the of laryngeal mask airway(LMA)in neonates and to assess its maneuverability, safety and efficacy. 
　Methods: 8 neonates undergoing elective plastic surgery were studied. Respiratory tract was maintained with laryngeal mask airway during general anesthesia. ECG, HR, RR and SpO₂ were observed and recorded before and after LMA insertion and during operation. Complications were recorded at LMA insertion，during operation and at LMA removal. Anesthesia was induced and maintained with volatile anaesthetic through a Jackson-Rees system.
　Results: Placement was successful in seven cases at the first attempt and one at the second attempt. There was no occurrence of complications（such as nausea，vomiting, aspiration, coughing, breathholding, laryngeal spasm, bronchospasm, airway obstruction, excessive salivation）at LMA insertion and in the course of operation and at LMA removal.
　Conclusions: LMA is a safe and effective form of airway management in neonates during general anaesthesia.
　Key words: laryngeal mask airway；paediatric anaesthesia; neonate
　Corresponding author: fruitXue@yahoo.com.cn

　　虽然有众多研究证实了喉罩气道（LMA）在1岁以内婴儿应用的安全性和有效性^[1-4]，但这些研究很少是单纯针对1个月以内新生儿进行的。新生儿的生理学和解剖学与大龄婴儿存在有明显的差异。本研究旨在评价1号LMA在新生儿中应用的可操作性、安全性和有效性。

                       　材料和方法
　　对我院麻醉中采用LMA维持呼吸道的新生儿患者进行回顾性筛查，最早的1例为1998年4月。由于我院的特点，所有这些患儿均为先天性唇裂患者（2例）或唇腭裂患者（6例），均行唇裂修复术。年龄为23h～14d（平均5.1±4.3d）。体重为2.7～3.8kg（平均3.3±0.4 kg）。男性6例，女性2例。有1例存在新生儿黄疸。所有患儿均不伴有其他畸形，均为ASAⅠ级。手术前4h停止喂乳、2h禁水。         

　　4．如果患儿合并有腭裂，为了防止通气罩被嵌入腭裂间隙，在通气罩完全进入口腔内后，操作者可将优势手的食指放在通气导管和通气罩的结合部位向内推送LMA（图3），而不是沿硬腭向内插入。应尽可能用食指将LMA推送至下咽部。然后用非优势手握持通气导管固定LMA在正确位置，再退出优势手的食指。<?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" />

　　5．用适量的空气充起通气罩。在给通气罩充气时，通常可见通气导管从口腔内稍微退出和甲状腺和环状软骨上面的组织轻微隆起（图2D）。
　　6．将LMA与通气环路相连接，并评估通气的满意程度（图2E）。胸廓和贮气囊随自主呼吸起伏而无肋间隙和锁骨上窝内陷，肺部听诊呼吸音正常，人工挤压贮气囊可有效辅助通气，表明LMA的位置正确。

                        　醉中管理
    麻醉维持采用Jackson-Rees回路吸入与麻醉诱导同样的挥发性麻醉药，并在手术切口实施局部神经阻滞。麻醉维持期采用自主呼吸，必要时给予人工辅助。手术结束后，关闭吸入麻醉药和N₂O，纯氧吸入，待患儿清醒后再拔除LMA。患儿清醒以呼吸道保护性反射恢复和吸痰刺激有张口动作为标志。手术中采用多功能惠普监护仪，连续进行心电图（ECG）和脉搏血氧饱和度（SpO₂）监测。

                        　观察项目
    观察和记录LMA的插入操作情况（操作次数、充气量）。观察和记录LMA插入操作前、后和手术中ECG、HR、RR和SpO₂的变化。记录LMA插入操作时、手术中和拔除时的并发症（恶心、呕吐、误吸、咳嗽、屏气、喉痉挛、支气管痉挛、呼吸道梗阻、口腔分泌物增加）。记录手术时间。
                         　统计学处理

　　所有数值采用均数±标准差（±s）表示，对LMA插入操作前、后的HR、RR和SpO₂值采配对t检验，以P<0.05为有显著性差异。              

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