持续气道正压通气用于小儿气管异物取出术的临床研究  

Clinical study for artificial ventilation combined continuous positive airway pressure with removal of tracheobronchial foreign bodies in children

作　　者：卢贵明[1] 廖锡强[1] 李卫明[1] 林云雁[2] 赵崇汉[1] 

机构地区：[1]江门市新会区人民医院麻醉科,广东省江门529100 [2]江门市新会区人民医院五官科,广东省江门529100

出　　处：《中国基层医药》2011年第2期185-187,共3页Chinese Journal of Primary Medicine and Pharmacy

基　　金：广东省江门市科技局立项项目（江科2009]77号）

摘　　要：目的观察人工通气加持续气道正压（CPAP）的方法在小儿气管异物取出术中的临床效果，探讨其可行性和安全性。方法60例在静脉复合全麻下行气管异物取出术的患儿，随机分为A组和B组，每组30例。A组采用人工通气加持续气道正压的通气方法，即在麻醉诱导完3min置入支气管镜，经支气管镜侧孔连接麻醉机行人工通气，同时给予高流量（10-15L／min）新鲜气流以保持持续气道正压；B组采用高频喷射通气（HFJV），频率为60-100次／min。若术中SpO2〈90％，则退出支气管镜予面罩通气，氧合改善后再行取异物。入室后监测MAP、HR、ECG、SpO2和PETCO2，定时采血测定PaO2和PaCO2等。记录入室即时（T0）、入镜即时（T1）、入镜后5min（（T2）、入镜后10min（T3）及术毕（T4）时MAP、HR、SpO2、PaO2和PaCO2值。观察两组不良反应发生情况，记录其退镜率和术毕插管率。结果两组患儿一般情况和MAP差异无统计学意义（P〉0．05）。两组HR在麻醉后比入室时明显下降（P〈0．01），但差异元统计学意义（P〉0．05）。两组SpO2和PaO2在麻醉后均比入室时明显升高（P〈0．01），同时A组PaO2在入镜后不同时段均明显高于B组（P〈0．05）。两组PaCO2在入镜后逐渐升高，但A组升高幅度明显低于B组（P〈0．05或0．01）。两组退镜率和插管率差异均无统计学意义（均P〉0．05），但B组总退镜和插管次数略高于A组。结论人工通气加持续气道正压的通气方法用于小儿气管异物取出术安全可行，可控性较好，呼吸功能影响小，值得推广。Objective To observe the clinical effect of artificial ventilation combined continuous positive air- way pressure（CPAP） with removal of tracheobronchial foreign bodies for children and to explore the possibility and security of the method. Methods 60 children with traeheobronchial foreign body, underwent total intravenous anesthesia ,were randomly divided into A group and B group. Each group had 30 cases. A group was given artificial ventilation with CPAP. The bronehofibroscope was connected to anesthesia machine with side hole after induction for 3 minutes ,and high fresh gas flow（ 10 - 15L/min ） was given to maintain continuous positive airway pressure. B group were given high frequency jet ventilation（HFJV） ,60 - 100 bpm. The mask ventilation was given in stand of bronchofibroseope when SpO2 〈 90% and until SpO2 improved. MAP, HR, ECG, SpO2, PaO2, PaCO2 were monitored and recorded at time points：T0 （entered operation room）, T1 （beginning of bronchofibroseopy）, T2 （5min after bronchofibroscopy） ,T3 （10 min after bronchofibroscopy） ,T4 （end of operation）. The side effects,the rate of fail to bronchofibroscopy and the rate of intubations after operation in two groups were observed and recorded. Results The HR of post-anesthesia in two groups significantly decreased than those at To （ P 〈 0.01 ） , but no difference showed in HR between two groups（ P 〉 0.05）. SpO, and PaO2 of post-anesthesia in two groups significantly increased than those at To （ P 〈 0. 01 ）, PaO2 at T1 , T2, T3 in A group were significantly higher than those in B group （ P 〈 0.05 ）. PaCO2 gradually in- creased after bronchofibroscopy in two groups ,and the values in A group was significantly lower than in B group（ P 〈 0.05 or 0. 01 ）. There were no significant differences in the rates of fail to bronehofibroscopy and of intubations after operation between two groups, but the total number of B group was higher. Conclusion Artificial ventilation with CPAP for children with removal of

关 键 词：人工通气 高频喷射 无创正压通气 气管异物 儿童 

分 类 号：R726[医药卫生—儿科]