声门下置硅塑管控制呼吸用于小儿气管异物取出术三峡大学仁和医院麻醉科(宜昌443002)张家骏简道林摘要目的: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SpO2、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SpO2<90%情况;术后由手术医师用VAS100mm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10例1次插入气管镜,�组有14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;SpO2<90%�组有6例、�组有3例;苏醒时间�组为58.4±20.9min,�组为13.8±4.6min;手术医师满意率�组为82.8±11.5mm,�组为97.6±9.9mm,有明显差异性(P<0.05);�组术中有1例发生喉痉挛,�组则无。25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(尤其是SpO2)。主题词气管支气管异物麻醉,全身@硅塑管Useofinsertingsilicon-plastictubeintosubglottisforventilationandundergoingremovalofforeignbodiesfromthetracheaandbronchusinchildrenDepartmentofAnesthesiology,RenheHospital,ThreeGorgesUniversity,HebeiProvince(Yichang443002)ZhangJiajunJianDaolinABSTRACTObjective:Tostudythepossibilityofuseofinsertingsilicon2plastictubeintosubglottisforventilationandforundergoingremovalofforeignbodiesfromthetracheaandbronchusinchildren.Methods:30childrenscheduledforremovalofforeignbodiesfromthetracheaandbronchuswererandomlydividedintogroup�(n=15)andgroup�(n=15).ketamine,sodiumhydroxybutyrateandotherdrugsweregivenforinductionandmaintainerofanesthesia,andspontaneousrespirationwaskeptingroup�.Ingroup�,afterrapidinductionofanesthesiawithpropofolandsuxamethonium,asilicon2plastictubewasinsertedintosubglottisandrespirationwascontrolledwithHFJVventilation.Theanesthesiawasmaintainedbycontinuousinfusionofprocaineorpropofolcombinedwithsuxamethonium.Results:Theage,weightandoperativetimehadnodifferenceinbothgroups.Thecasesofinsertingbronchoscopeintotracheaatfirsttimewas10ingroup�and14ingroup�.Thechildrennumbersofoccurringbreathholdingandbuckingwere3and6respectivelyingroup�,Iandnoneingroup�.ThecasesofSpO2<90%were6ingroup�and3ingroup�.Theawakentimewas58.4±20.9minsingroup�and13.8±4.6minsingroup�(P<0.05);VASthatexpressedsurgeon’satisfactorydegreeforoperativeconditionwas82.8±11.5mmingroup�and97.6±9.9mmingroup�(P<0.05).onecaseoccurredlarynxspasmingroup�.Conclusion:Useofinsertingsilicon2plastictubeintosubglottisforventilationwasakindofsafeandpracticalanestheticmethod,comparingwithordinaryoneinchildrenforundergoingremovalofforeignbodiesfromthetracheaandbronchus.SUBJECTWORDSTracheaBronchiAnesthesia,general@Silicon2plastictube041陕西医学杂志2004年2月第33卷第2期小儿气管异物取出术,常在保留自主呼吸下进行,但术中屏气、呛咳发生率高,术后苏醒较慢。本研究探讨快速诱导、声门下置硅塑管用高频喷射通气控制呼吸进行此类手术的可行性,并比较两者的麻醉效果。资料和方法30例患儿,男21例,女9例,年龄1.5～12岁,体重11～34kg,病程8h至7个月,随机分为两组,每组15例,两组年龄、体重、手术时间见表1。术前肌注阿托品0.02mg�kg,部分患儿合用苯巴比妥钠2mg�kg。不合作的患儿肌注氯安酮4～6mg�kg先行基础麻醉后入手术室,继而开放静脉,同时面罩给氧,监测BP、HR、SpO2、ECG,...
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