漏斗胸患儿行胸腔镜Nuss手术的麻醉处理  

Anesthetic management for pediatric patients undergoing thoracoscopic Nuss procedure

作　　者：朱明 陈煜[1] 

机构地区：[1]上海交通大学医学院附属上海儿童医学中心麻醉科,200127

出　　处：《上海医学》2009年第1期40-42,共3页Shanghai Medical Journal

摘　　要：目的探讨漏斗胸患儿行胸腔镜Nuss手术的麻醉处理。方法2004年6月-2007年2月行择期漏斗胸Nuss纠治手术70例,男46例,女24例,年龄18个月～14岁,平均年龄为(7.5±3.5)岁;体重14～63kg,平均体重为(25.2±10.8)kg。以咪达唑仑0.1mg/kg、芬太尼20μg/kg和维库溴铵0.1mg/kg静脉诱导,行气管插管。插管成功后连接呼吸机以压力控制模式进行机械通气,气道压力维持在18～20cmH2O(1cmH2O=0.098kPa),呼吸频率15～20次/min;静脉滴注维库溴铵以维持肌松间吸入异氟烷以维持麻醉深度;置入胸腔镜后以4～6mmHg(1mmHg=0.133kPa)压力持续输入CO2气流,使肺叶部分塌陷,以配合手术操作。术中监测心电图、脉搏血氧饱和度、呼气末二氧化碳分压及呼吸功能等。结果70例患儿均顺利完成手术,6例术后胸部X线片显示少量气胸,经穿刺抽气消失。无其他并发症。结论在Nuss手术中以4～6mmHg压力输入CO2进行人工气胸,术中加强呼吸、循环管理,能较好地达到手术目的,且对患儿的生理功能影响较小。Objective To report our experience on the anesthetic management for pediatric patients undergoing video-assisted thoracoscopic Nuss procedure. Methods From June 2004 to February 2007, Nuss procedure was performed in 70 patients with pectus excavatum in our hospital. Of these patients, forty-six were males. The average age was （7.5±3.5） years （ranging from 18 months to 14 years）, the average weight was （25.2± 10.8） kg （ranging from 14 to 63 kg）. Midazolam 0.1 mg/kg, fentanyl 20μg/kg and vecuronium 0.1 mg/kg were used as anesthesia induction before intubation. After intubation, the patients were ventilated in a pressure control mode keeping the airway pressure between 18 to 20 cm H2O （1 cm H2O= 0. 098 kPa）, with the ventilation rate being 15 to 20 per minute. Vecuronium, isoflurane inhalation or propofolum were used to deepen anesthesia. When thoracoscope was inserted, 4--6 mmHg （1 mmHg= 0. 133 kPa） CO2 was insuffiated persistently to expedite lung collapse. ECG, SpO2, EtCO2 and respiratory function were monitored during the operation. Results Operation was successful in all patients. Six patients developed postoperative pneumothorax and resolved after percutaneous aspiration. There were no other complications. Conclusion During Nuss procedure, induction of artificial pneumothorax by 4- 6 mmHg CO2 insufflation is safe and beneficial for the operation. Satisfied operation results can be achieved under intense anesthetic respiratory and circulation managements.

关 键 词：儿童 麻醉 漏斗胸 手术 

分 类 号：R726.1[医药卫生—儿科]