新生儿单肺通气的麻醉管理(附20例报告)

目的探讨新生儿食管端端吻合手术中单肺通气(OLV)麻醉的可行性和安全性.方法对20例日龄4h～17d、体重1.5～3.2kg的食管闭锁及气管食管瘘患儿,快速诱导后,在正气管插入单腔气管导管,右侧开胸,使术侧肺脏压迫萎陷造成左侧单肺通气(OLV).术中连续监测心率(HR)、动脉压(ABP)、心电图(ECG)、脉搏血氧饱和度(SpO2)、呼气末CO2分压(PETCO2)、体温(T);记录诱导前后OLV10min、OLV30min,术毕的SpO2、PETCO2、HR值,比较各时段呼吸循环参数变化.结果全部患儿单肺通气后SpO2均有下降,经适当处理,14例患儿SpO2维持在95%以上.3例患儿应用呼气末正压通气(PEEP),可维持SpO2在94%以上.另3例患儿在暂停手术操作、恢复双肺通气后,SpO2恢复正常.与诱导后相比,PETCO2在单肺通气后10min及30min分别为(30.2±3.6)、(29.5±4.8)mmHg,显著低于诱导后的(35.1±0.6)mmHg(P＜0.05).HR在单肺通气后各时段呈显著降低趋势(P＜0.05).结论采用正气管插管技术,应用合理的呼吸管理,适当的麻醉用药,新生儿单肺通气行类似于食管端端吻合手术是安全可行的.

Anesthetic management of one lung ventilation surgery in newborn operations(report of 20 cases)

Objective To investigate the feasibility and safety of one-lung ventilation(OLV)anesthesia on newborns scheduled for esophagoplasty. Methods 20 patients suffered from esophageal atresia and tracheoesophageal fistula were enrolled in this study. The age ranged from 4 hours to17 days and their body weight ranged form 1.5 to 3.2kg. Endotracheal intubation was performed after rapid anesthesia induction and anesthesia was maintained with isoflurance and propofol.One lung was ventilated during operation because the operative lung was compressed. HR?ABP?SpO2?PETCO2?T were continuously monitored and HR?SpO2?PETCO2 were recorded at scheduled intervals in each patient. The change of these cardiorespiratory parameters were compared. Results The SpO2 of all the 20 neonates were reduced because of OLV ,14 of them were increased to 95% after several interventions and 3 cases maintained at 94% steadly by the utilization of PEEP. Operation of the other 3 cases had to be suspended temporarily and restored two-lung ventilation because of hypoxemia. Operation continued after SpO2 was increased to normal level. Compared with the data after anesthesia induction, the changes of PETCO2 was significantly lowered at the 10 minute and the 30 minute after OLV(P<0.05). The HR was markedly decreased during the course of OLV. Conclusions Endotracheal intubation, combined with appropriate respiratory managements and drug usage, are feasible and safe for OLV neonates scheduled as esophagoplasty.