先天性食管闭锁伴气管食管瘘围术期的呼吸管理

目的探讨先天性食管闭锁伴气管食管瘘围术期的呼吸管理，以减少肺部并发症发生，提高治愈率。方法回顾性分析8例先天性食管闭锁伴气管食管瘘病儿术前、麻醉术中、术后的呼吸管理过程。结果6例采取了慢诱导气管内插管保留自主呼吸，气管食管瘘管钳闭后完全控制呼吸管理，术后胸片显示，无明显肺不张及肺炎加重。2例快诱导病例出现胃胀气，气道阻力逐渐增加，术后胸片显示肺炎加重并出现肺不张。8例均无麻醉死亡。7例治愈出院，1例因核黄疸放弃治疗。结论早诊断、禁食、置胃管、积极有效吸引是减少吸人性肺炎的关键；术中麻醉采用慢诱导气管内插管保留自主呼吸与气管食管瘘管钳闭后完全控制呼吸相结合的呼吸管理能有效减少术后肺部并发症。

Respiratory management of perioperative patients with congenital esophageal atresia accompanied by tracheo-esophageal fistula

Objective To investigate the respiratory management of the perioperative patients with congenital esophageal atresia accompanied by tracheo-esophageal fistula. Methods The respiratory management during the pre-, intra-, and post-operative processes in 8 child patients with congenital esophageal atresia accompanied by tracheo-esophageal fistula was analyzed retrospectively. Results Post-operative X-ray revealed that 6 patients who received endotracheal intubation and controlled respiration after slow induction had no significant atelectasis or more severe pneumonia. Stomach gassiness and increased airway resistance were observed in 2 patients who received fast induction, although there were stable vital signs and 92%-97% oxygen saturation. More severe pneumonia accompanied by atelectasis happened in the two patients. No death due to anesthesia happened in these 8 patients. Seven patients were discharged after recovery and one patient gave up because of nuclear jaundice. Conclusion Early diagnosis, fasting, gastric cannula, and active aspiration are important to reduce aspiration pneumonia. Pulmonary complications can be reduced effectively and the same stable anesthesia can be obtained if combined the existed autonomous breathing after slow induction with controlled breath after blocking up the fistula cannula.