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Lancet:婴儿手术中,喉罩麻醉优于气管插管麻醉

2017-01-19 MedSci MedSci原创

背景:围手术期呼吸不良事件(PRAE) 是小儿麻醉最常见的危险事件,同时更常见于婴幼儿中。既往的研究已经发现,在较大的儿童(> 1岁)中,与气管插管相比,使用喉罩(LMA)与减少PRAE相关。本研究的目的是在更小的儿童中评估这些设备对PRAE发生率的影响。

围手术期呼吸不良事件(PRAE) 是小儿麻醉最常见的危险事件,同时更常见于婴幼儿中。既往的研究已经发现,在较大的儿童(> 1岁)中,与气管插管相比,使用喉罩(LMA)与减少PRAE相关。那更小的婴儿中情况如何?最新一期的Lancet刊登了一项研究,目的是在更小的儿童中评估这些设备对PRAE发生率的影响。

这是一项随机对照试验,来自玛格丽特公主医院的研究人员在澳大利亚珀斯招募婴幼儿(年龄0-12个月),受试者接受了芬太尼1 μg/kg的一般麻醉与预期芬太尼剂量为1μ克/公斤或剂量更低的小手术,研究排除了存在喉罩或气管插管禁忌的患者;心脏病患者、呼吸道或胸廓畸形患者;咪达唑仑使用者;研究期间进行气道、胸或腹部手术的患者;以及父母不会英语者。登记前获得家长或监护人同意。参与者被随机分配(1:1),由计算机生成的可变块随机分组,接受LMA(中国)或气管插管(美国)。当招募到所需婴幼儿数目的一半(145例)时,进行中期分析。主要终点是PRAE的发生率,在意向性治疗人群中进行评估。

该试验于2010年7月8日开始,并于2015年5月7日结束。在这段时间里,研究人员评估了239名婴儿,181例符合条件并随机接受LMA(n = 85)或气管插管(n = 95),分析时排除了四名婴儿。在对意向性治疗的分析中,在气管插管组有50例(53%)婴儿发生PRAE,在喉罩组有15例(18%)(风险比[RR],2.94;95% CI,1.79-4.83,P<0.0001)。喉痉挛、支气管痉挛(主要的PRAE)的发生率分别为:气管插管组18例(19%)vs喉罩组3例(4%)(RR,5.30;95% CI,1.62-17.35,P = 0.002)。无死亡病例报告。

在接受小的选择性外科手术时,与气管插管麻醉相比,喉罩麻醉与临床明显较少
围手术期呼吸不良事件和较少主要PRAE(喉痉挛、支气管痉挛)的发生相关。


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    2017-11-25 howi
  2. [GetPortalCommentsPageByObjectIdResponse(id=1828747, encodeId=850a1828e47db, content=<a href='/topic/show?id=1b6210686b2' target=_blank style='color:#2F92EE;'>#Lancet#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=92, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10686, encryptionId=1b6210686b2, topicName=Lancet)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3f0227, createdName=howi, createdTime=Sat Nov 25 08:56:00 CST 2017, time=2017-11-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=174953, encodeId=1d371e4953df, content=在接受小的选择性外科手术时,与气管插管麻醉相比,喉罩麻醉与临床明显较少围手术期呼吸不良事件和较少主要PRAE(喉痉挛、支气管痉挛)的发生相关。, beContent=null, objectType=article, channel=null, level=null, likeNumber=115, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e6501973775, createdName=流恋离殇, createdTime=Wed Feb 08 12:47:15 CST 2017, time=2017-02-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=172380, encodeId=e1de1e23802e, content=还是相信插管全麻, beContent=null, objectType=article, channel=null, level=null, likeNumber=122, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=43242003153, createdName=1e1d0ffbm72(暂无匿称), createdTime=Tue Jan 24 16:23:20 CST 2017, time=2017-01-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1472345, encodeId=a01d14e23456d, content=<a href='/topic/show?id=4ea863841a9' target=_blank style='color:#2F92EE;'>#气管插管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=126, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63841, encryptionId=4ea863841a9, topicName=气管插管)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cb5b7213173, createdName=yangfl08, createdTime=Sat Jan 21 09:56:00 CST 2017, time=2017-01-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=171594, encodeId=bbbe1e15946f, content=学习到了, beContent=null, objectType=article, channel=null, level=null, likeNumber=125, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKPeeEwPQq9TMKicgf58mJaQxKhBsHa2jnPrEYVBnZ8QD4tbiaUo3aNqM7EUfOzoPiaEELUb7VRE0HKA/132, createdBy=afcb2012691, createdName=1e1f3a67m99(暂无匿称), createdTime=Fri Jan 20 14:24:32 CST 2017, time=2017-01-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=171578, encodeId=69371e15783e, content=好好学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=139, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Fri Jan 20 11:34:17 CST 2017, time=2017-01-20, status=1, ipAttribution=)]
    2017-02-08 流恋离殇

    在接受小的选择性外科手术时,与气管插管麻醉相比,喉罩麻醉与临床明显较少围手术期呼吸不良事件和较少主要PRAE(喉痉挛、支气管痉挛)的发生相关。

    0

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    2017-01-24 1e1d0ffbm72(暂无匿称)

    还是相信插管全麻

    0

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    2017-01-20 1e1f3a67m99(暂无匿称)

    学习到了

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=1828747, encodeId=850a1828e47db, content=<a href='/topic/show?id=1b6210686b2' target=_blank style='color:#2F92EE;'>#Lancet#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=92, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10686, encryptionId=1b6210686b2, topicName=Lancet)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3f0227, createdName=howi, createdTime=Sat Nov 25 08:56:00 CST 2017, time=2017-11-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=174953, encodeId=1d371e4953df, content=在接受小的选择性外科手术时,与气管插管麻醉相比,喉罩麻醉与临床明显较少围手术期呼吸不良事件和较少主要PRAE(喉痉挛、支气管痉挛)的发生相关。, beContent=null, objectType=article, channel=null, level=null, likeNumber=115, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e6501973775, createdName=流恋离殇, createdTime=Wed Feb 08 12:47:15 CST 2017, time=2017-02-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=172380, encodeId=e1de1e23802e, content=还是相信插管全麻, beContent=null, objectType=article, channel=null, level=null, likeNumber=122, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=43242003153, createdName=1e1d0ffbm72(暂无匿称), createdTime=Tue Jan 24 16:23:20 CST 2017, time=2017-01-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1472345, encodeId=a01d14e23456d, content=<a href='/topic/show?id=4ea863841a9' target=_blank style='color:#2F92EE;'>#气管插管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=126, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63841, encryptionId=4ea863841a9, topicName=气管插管)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cb5b7213173, createdName=yangfl08, createdTime=Sat Jan 21 09:56:00 CST 2017, time=2017-01-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=171594, encodeId=bbbe1e15946f, content=学习到了, beContent=null, objectType=article, channel=null, level=null, likeNumber=125, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKPeeEwPQq9TMKicgf58mJaQxKhBsHa2jnPrEYVBnZ8QD4tbiaUo3aNqM7EUfOzoPiaEELUb7VRE0HKA/132, createdBy=afcb2012691, createdName=1e1f3a67m99(暂无匿称), createdTime=Fri Jan 20 14:24:32 CST 2017, time=2017-01-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=171578, encodeId=69371e15783e, content=好好学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=139, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Fri Jan 20 11:34:17 CST 2017, time=2017-01-20, status=1, ipAttribution=)]
    2017-01-20 忠诚向上

    好好学习

    0

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