儿童硬质支气管镜探查术围手术期血氧耐受不良因素探讨及处理对策

目的探讨硬质支气管镜探查术围手术期血氧耐受不良的影响因素,分析并提出处理对策。方法回顾性分析2001年1月～2010年12月1660例行全麻下硬质支气管镜探查术患儿围手术期情况,对患儿疾病的种类、合并症以及术中血氧饱和度的变化等进行归纳分析。结果探查过程中,非呼吸道异物（如肺部炎性疾病等）患者出现血氧耐受不良56.47%（96/170）,呼吸道异物患者出现血氧耐受不良19.48%（378/1490）;呼吸道异物合并贫血,或术前合并纵隔、皮下气肿以及非单侧支气管异物患儿,术中出现血氧耐受不良的比例分别为80.77%（42/52）、74.29%（52/70）和51.82%（214/413）,分别与不合并贫血、无并发症及单侧支气管异物比较,有显著性差异（P〈0.01）。结论肺部炎性疾病、呼吸道异物患儿中的非单侧支气管异物、异物合并有贫血者以及术前存在并发症的异物患者,容易出现血氧耐受不良,术中采取加压给氧和/或快速取出异物、吸除管腔内分泌物,可有效改善血氧耐受不良。

Risk factors of oxygen desaturation and effective treatment during rigid bronchoscopy in children

OBJECTIVE To investigate the risk factors of oxygen desaturation and effective treatment during rigid bronchoscopy in children.METHODS Between Jan 2001 to Dec 2010,1660 cases had been treated by rigid bronchoscopy,the fluctuation of oxygen desaturation of these patients was recorded and analyzed.RESULTS All of the patients were fully recovered.The fluctuation of oxygen desaturation occurred more frequent in children with lung inflammatory diseases（96 of 170 cases had desaturation）than in children with foreign body in airway（378 of 1490 cases had desaturation）.The children with foreign body in airway and anemia（42 of 52 cases had desaturation）,complications（52 of 70 cases had desaturation）and with bilateral bronchial foreign body（214 of 413 cases had desaturation）were prone to cause desaturation（P 0.01）.CONCLUSION Risk factors of fluctuation of oxygen desaturation included lung inflammatory diseases,anemia,complications and bilateral bronchial foreign body.Increasing the oxygen pressure,remove foreign body quickly and suction of the secretions in bronchus were effective measures for increasing the oxygen saturation.