儿童危重气管支气管异物的气道管理及麻醉体会

目的 探讨危重气管支气管异物患儿硬质气管镜检查术中适宜的气道管理及麻醉方案。 方法 选取134例危重气管支气管异物患儿,患儿进入手术室后给予面罩无创机械通气或经气管插管加压给氧,静脉注射盐酸戊乙奎醚0.03 mg/kg,地塞米松0.4~0.5 mg/kg。呼吸窘迫不明显的119例患儿采用不保留自主呼吸的静脉麻醉方式,已出现呼吸窘迫的13例患儿采取保留自主呼吸的静脉麻醉方式;呼吸窘迫严重导致紫绀、意识不清的2例患儿由耳鼻喉科医师紧急置入硬质气管镜。术中根据血氧情况间断给予高频喷射呼吸机喷射给氧,高频通气频率60~80次/min,吸呼比1∶1.5,驱动压不超过60 kPa。术毕观察患儿呼吸及神志恢复情况,待自主呼吸恢复,刺激有反应后转回耳鼻喉科术后监护室或儿科ICU进行进一步治疗。 结果 134例危重气管支气管异物患儿均一次手术成功取出异物,无严重喉痉挛及支气管痉挛情况,无因屏气呛咳被迫退镜情况发生,无麻醉意外发生。1例患儿术前缺氧时间过长,术后8 h因多脏器功能衰竭抢救无效死亡;其余患儿术后缺氧改善,自主呼吸平稳,经治疗3~8 d后痊愈出院。 结论 硬质气管镜检查术中麻醉医师需根据呼吸困难程度采用不同的麻醉方案,保证充分氧供,避免胃内容物误吸、气道痉挛,协助耳鼻喉医师尽快解除气道梗阻。

Airway management and anesthesia method of children with tracheobronchial foreign bodies

Objective To investigate feasible airway management and anesthesia protocols during rigid bronchoscopy for critical children with tracheobronchial foreign bodies. Methods We selected 134 critical children with tracheobronchial foreign bodies. After the children entered the operating room, they were supplied oxygen via a face mask or underwent endotracheal intubation. Preoperative medication was usually administered intravenously and included penehyclidine hydrochloride(0.03 mg/kg)and dexamethasone(0.4~0.5 mg/kg). Among the patients, 119 without respiratory distress syndrome were administered low doses of rocuronium together with intravenous anesthesia; 13 with respiratory distress were administered intravenous anesthesia to preserve spontaneous breathing; and two with severe respiratory distress and unconsciousness underwent rigid bronchoscopy performed by an otolaryngologist. High-frequency jet ventilation was discontinuously implemented based on the intraoperative blood oxygen level, with a ventilation frequency of 60-80 times per minute, an I/E ratio of 1∶1.5, and a drive pressure not exceeding 60 kPa. After completion of the surgery, we ensured the recovery of spontaneous respiration; no significant postoperative vomiting and respiratory depression occurred. Thereafter, the children were transferred to either the postoperative care room for otolaryngology patients or the PICU for further observation. Results The foreign bodies in each of the children were successfully removed through a single operation. No serious laryngospasm or bronchospasm, forced withdrawal of the mirror due to breath holding or coughing, or anesthesia accident occurred during the operations. Owing to prolonged hypoxia, one patient died of multiple organ failure 8 hours after the operation. The remaining patients recovered with stable postoperative vital signs and were discharged after 3-8 days of treatment. Conclusion Anesthesiologists should adopt different anesthetic protocols during rigid bronchoscopy, based on the degree of dyspnea, to ensure adequate oxygen supply, to avoid false aspiration of gastric contents, and to prevent airway spasms, and should assist otolaryngologists in relieving airway obstruction as soon as possible.