新生儿食管闭锁(Ⅲ型)术中气管食管瘘管对低氧血症的影响  

Effect of Tracheoesophageal Fistula on Neonatal Hypoxemia in Type Ⅲ Esophageal Atresia Surgery

作　　者：邓萌[1] 张学锋[1] 汤顺荣[1] 郑珊[1] 

机构地区：[1]复旦大学附属儿科医院麻醉科,上海200032

出　　处：《临床小儿外科杂志》2005年第2期94-96,共3页Journal of Clinical Pediatric Surgery

摘　　要：目的通过回顾我院24例食管闭锁伴气管食管瘘患儿的麻醉管理,探讨此类患儿围术期低氧血症的预防和治疗措施。方法24例患儿,术前30min肌注阿托品0.02mg/kg。异丙酚3mg/kg,维库溴铵0.1mg/kg～0.15mg/kg静脉注射诱导气管插管。使用Drager麻醉机,行间歇正压通气穴IPPV雪,FiO2100%,术中根据患儿情况调整呼吸机参数。麻醉维持吸入1%～2%异氟醚,切皮前静注芬太尼1μg/kg～2μg/kg。根据手术时间必要时可单次追加维库溴铵0.05mg/kg熏芬太尼1μg/kg。记录术前、麻醉诱导后、瘘管结扎前5min、瘘管结扎后5min、手术结束时HR、SpO2、PETCO2和体温。结果瘘管结扎前5minSpO290.2%±3.3%、PETCO222.0±4.0mmHg与瘘管结扎后5minSpO295.1%±2.6%、PETCO238.2±5.8mmHg比较,P<0.05。结论气管食管瘘管的存在与术中低氧血症的发生发展密切相关;瘘管结扎后,低氧血症可有明显改善。Objective To investigate the prevention and treatment of hypoxemia peri-operation through anesthetic management of 24 cases of esophageal Atresia complicated with tracheoesophgeal fistula of hospitalization neonates in our hospital. Methods Atropine 0.02mg/kg was injected intramuscularly at 30 min before operation; After anesthesia induction with Propofol 3mg/kg and Vecuronium 0.1 mg/kg-0.15 mg/kg intravenously ,the baby was intubated. Intermittent positive pressure ventilation （IPPV） was used. Anesthesia was continued with 1%-2% Isoflurane in 100% oxygen. Fentanyl 1μg/kg-2μg/kg was given intravenously before incision of the skin. During the operations,Vecuronium 0.05mg/kg and fentanyl 1μg/kg were again administered intravenously only one time in case necessary. The data of HR,SpO2, PETCO2 and body temperature were recorded asfollows time： before the operation,after anesthesia induction, 5min before tracheoesophageal fistula ligation, 5 min after tracheoesophageal fistula（TEF） ligation and at the end of the operation. Results the data of SpO290.2%±3.3%,PETCO222.40±4.0mmhg at 5 min before tracheoesophageal fistula （TEF） ligation were significantly lower than the data of SpO295.1%±2.6%,PETCO238.2±5.8mmhg at 5min after TEF ligation（P〈0.05）.Conclusion The TEF exists in the patient is closely relation to the development of hypoxemia in the perioperation.The TEF is quicker ligated,the better outcome of patients will be.

关 键 词：食管闭锁/外科学 气管食管瘘 低氧血症 

分 类 号：R726.1[医药卫生—儿科]