声门下置硅塑管控制呼吸用于小儿气管异物取出术

目的 :探讨快速诱导行声门下置硅塑管控制呼吸用于气管异物取出术的可行性。方法 :30例行气管异物取出术的患儿 ,随机分为两组。 组于常规氯安酮、羟丁酸钠麻醉 ,保留自主呼吸进行。 组经快速诱导 ,于声门下置入细硅塑管 ,用高频喷射呼吸机控制呼吸 ,普鲁卡因或丙泊酚复合琥珀胆碱维持麻醉 ,术中监测 Sp O2 、BP、HR、ECG。比较术中两组 1次气管镜置入率、屏气呛咳、苏醒时间及 Sp O2 <90 %情况 ;术后由手术医师用 VAS1 0 0 mm对麻醉的满意程度进行评估。结果 :两组在年龄体重 ,手术时间无明显差异。 组有1 0例 1次插入气管镜 , 组有 1 4例。术中 组有 3例发生屏气 ,6例发生呛咳 ,而 组只有1例呛咳 ,无 1例发生屏气 ;Sp O2 <90 % 组有 6例、 组有 3例 ;苏醒时间 组为 5 8.4±2 0 .9min, 组为 1 3.8± 4.6min;手术医师满意率 组为 82 .8± 1 1 .5 mm, 组为 97.6± 9.9mm,有明显差异性 ( P<0 .0 5 ) ; 组术中有 1例发生喉痉挛 , 组则无。 2 5例取出气管异物 ,5例未取出 ,术后有 2例咳出。结论 :快速诱导后声门下置硅塑管控制呼吸用于气管异物取出术 ,声门暴露良好便于气管镜的插入 ,术中不发生屏气、呛咳 ,病人苏醒快 ,术后并发症少 ,不失为一种比较安全实用的麻醉方法 ,但术中及术后均需加强监测

Use of inserting silicon-plastic tube into subglottis for ventilation and undergoing removal of foreign bodies from the trachea and bronchus in children

Objective:To study the possibility of use of inserting silicon plastic tube into subglottis for ventilation and for undergoing removal of foreign bodies from the trachea and bronchus in children. Methods:30 children scheduled for removal of foreign bodies from the trachea and bronchus were randomly divided into groupⅠ( n =15)and groupⅡ( n =15) . ketamine, sodium hydroxybutyrate and other drugs were given for induction and maintainer of anesthesia, and spontaneous respiration was kept in group Ⅰ.In groupⅡ,after rapid induction of anesthesia with propofol and suxamethonium , a silicon plastic tube was inserted into subglottis and respiration was controlled with HFJV ventilation. The anesthesia was maintained by continuous infusion of procaine or propofol combined with suxamethonium. Results:The age, weight and operative time had no difference in both groups. The cases of inserting bronchoscope into trachea at first time was 10 in groupⅠand 14 in groupⅡ.The children numbers of occurring breath holding and bucking were 3 and 6 respectively in groupⅠ, I and none in groupⅡ. The cases of SpO 2<90% were 6 in groupⅠand 3 in groupⅡ.The awaken time was 58.4±20.9 mins in groupⅠand 13.8±4.6 mins in groupⅡ( P <0.05);VAS that expressed surgeon' satisfactory degree for operative condition was 82.8±11.5 mm in groupⅠand 97.6±9.9 mm in groupⅡ( P <0.05). one case occurred larynxspasm in groupⅠ.Conclusion: Use of inserting silicon plastic tube into subglottis for ventilation was a kind of safe and practical anesthetic method,comparing with ordinary one in children for undergoing removal of foreign bodies from the trachea and bronchus.