新生儿先天性食管闭锁及气管食管瘘围术期的呼吸管理

目的探讨新生儿先天性食管闭锁及气管食管瘘围术期的呼吸管理,术中单肺通气(OLV)的临床应用及其安全性。方法 18例年龄6h～10d、体重1380～3100g、行食管闭锁及气管食管瘘食管端端吻合术患儿,麻醉诱导静脉注射阿托品0.01mg/kg、芬太尼2μg/kg、维库溴铵0.1mg/kg,面罩吸2%～4%七氟醚1min,气管插管尽可能插过气管食管瘘口。使用压力控制通气呼吸模式。麻醉维持吸入1%～3%七氟醚。术中压迫右侧肺,使其尽量萎陷,造成左肺OLV,调节呼吸参数,维持SpO2>90%。术中监测ECG、SpO2、PETCO2、BP、T。记录麻醉诱导前后、OLV10min、30min及术毕时的SpO2、PETCO2、HR、T。结果 OLV后所有患儿SpO2均有不同程度下降,适当调节呼吸参数,3例使用呼气末正压通气(PEEP),其中1例肺部感染重的患儿间隔恢复双肺通气,使SpO2维持90%以上。OLV30min,17例患儿SpO2较OLV10min时升高(P<0.05)。OLV10、30min时HR均较诱导后减慢。术中T维持在35.5～37.0℃。全部患儿术后安全返回病房。结论新生儿先天性食管闭锁及气管食管瘘围术期,采用单腔气管插管,术中人工肺萎陷法OLV麻醉时,恰当的呼吸管理,应用压力控制通气,七氟醚吸入维持麻醉是安全有效的。

Respiratory management of perioperative neonates with congenital esophageal atresia and tracheaesophageal fistula

Objective To investigate the respiratory management of the perioperative neonates with congenital esophageal atresia and trachea-esophageal fistula, and discuss the clinical feasibility and safety of one-lung ventilation (OLV) in newborn operations.Methods Eighteen patients suffered from esophageal and tracheoesophageal fistula were enrolled in this study. The age ranged from 6 h-10 d and weigh ranged from 1 380-3 100 g. Atropine 0.01 mg/kg, fentanyl 2 μg/kg, vecuronium 0.1 mg/kg were injected via intravenous, 2%-4% sevoflurane were given on mask. Anesthesia was maintained with 1%-3% sevoflurane. One lung was ventilated during operation while the operative lung was compressed. The ventilator parameters were regulated to SpO2>90%. HR,ABP,SpO2,PETCO2,T were continuously monitored. The time of start and end OLV were recorded. HR,SpO2,T were compared at the time points of before, after anesthesia, OLV 10,30 min and end of operation.Results The SpO2 of all the 18 neonates were reduced because of OLV. But 30 min later, the SpO2 of the all maintained at >90%. 3 cases of them utilized PEEP. SpO2 of 17 cases at the 30 min OLV were higher than that of the 10 min OLV. The HR was decreased during the course of OLV.The temperature kept at 35.5-37.0 ℃ during the operation.All babies went back the ward safely. Conclusion Endotracheal intubation, OLV is compressed completely in operation, appropriate respiratory managements, using pressure control ventilation and sevoflurane maintain anesthesia are safely and feasible.