支撑喉镜下CO_2激光治疗声门下息肉的麻醉管理

目的 探讨非气管插管高频喷射通气(High-Frequency Jet Ventilation,HFJV)全凭静脉麻醉方法应用于声门下息肉激光切除的可行性.方法 42例ASAⅠ级～Ⅱ级声门下息肉手术患者,采用瑞芬太尼复合丙泊酚全凭静脉麻醉.在置人支撑喉镜前气管插管,机械控制通气,置入支撑喉镜即刻拔除气管插管,应用内径2.5 mm,外径3.0 mm 的金属导管于声门下5 cm处HFJV.术中持续监测并记录诱导前、气管插管机械控制通气后5 min、置入支撑喉镜即刻、HFJV后1 min、HFJV后5 rain、HFJV后10 min、HFJV后15min的心率(HR)、平均动脉压(MAP)、心电图(ECG)和脉搏氧饱和度(SpO_2);在置入支撑喉镜拔除气管插管即刻和HFJV后15 min采集足背动脉血进行血气分析.记录术毕患者苏醒情况、麻醉时间和手术时间.结果 麻醉时间(30.1±3.8)min,手术时间(7.9±2.6)min,术中各时间点HR、MAP与支撑喉镜置入即刻相比差异有统计学意义(P<0.01),但与诱导前相比差异无统计学意义(P>0.05);术中所有患者保持SpO_2≥99%;HFJV后15 minPaCO_2较拔除气管插管即刻升高,差异有统计学意义(P<0.01),但均低于70 mm Hg.结论 非气管插管HFJV全凭静脉麻醉可安全用于声门下息肉激光切除.

Anesthetic management for CO_2 laser treatment of polyp below glottis under self-retaining laryngoscope

Objective To investigate the application of intravenous anesthesia and high frequency jet ventilation (HFJV) without intubation for ectomy of polyp below glottis with laser. Methods 42 patients (ASA Ⅰ-Ⅱ) preparing for ectomy of polyp below glottis with laser were anesthetized intravenously with remifentenal and propofol. The patients were intubated and mechanical ventilated, and then extubated immediately after suspension laryngoscope insertion. A slender metal tube (ID2.5 mm, OD3.0 mm) which top was set 5 cm below glottis was used for airway management with HFJV. The heart rate(HR), mean arterial pressure(MAP),electrocardiogram (ECG) and pulse oxygen saturation (SpO_2) were continuously monitored before induction, immediately after intubation and mechanical ventilation 5 min, immediately and after suspension laryngoscope insertion, after HFJV 1 rain, 5 rain, 10 min and 15 rain. Blood gas analysis was carried out from the dorsal artery of foot at the point of immediately after suspension laryngoscope insertion and 15 min after HFJV. Analepsia time, anesthesia time, and the operation time were recorded. Results The anesthesia time was (30.1±3.8) min and the operation time was (7.9±2.6) min. The SpO_2≥99% for all patients. The HR and the MAP were significant differences (P<0.01)compared with the point of immediately after suspension laryngoscope insertion, but no significant differences (P>0.05)compared with the point of before induction. The PaCO_2 at the point of 15 min after HFJV was increased compared with extubation (P<0.01), but lower than 70 mm Hg. Conclusion Intravenous anesthesia and HFJV without intubation is safe for the ectomy of polyp below glottis with laser.