27例硬质支气管镜呼吸道微创手术的麻醉和通气管理  

Anesthesia and ventilation management of video-assisted rigid bronchoscopy in treatment of twenty-seven patients with respiratory tract disease

作　　者：刘建明[1] 李明星[1] 陈昶[2] 段若望[1] 

机构地区：[1]同济大学附属上海市肺科医院麻醉科,上海市200433 [2]同济大学附属上海市肺科医院胸外科,上海市200433

出　　处：《临床麻醉学杂志》2011年第11期1080-1082,共3页Journal of Clinical Anesthesiology

摘　　要：目的探讨硬质支气管镜呼吸道微创手术的麻醉方式和通气管理。方法 27例气道手术患者,ASAⅡ～Ⅳ级,全麻诱导后插入带自制套囊的硬质支气管镜,手控间歇正压通气。记录麻醉前(T1)、置镜时(T2)、手术开始后15min(T3)、30min(T4)、60min(T5)以及拔管后30min(T6)的HR、MAP、PaO2和PaCO2;记录术者置镜满意率。记录ASAⅡ和ASAⅢ或Ⅳ级患者术中及术后不良反应。结果 24例(89%)患者置镜满意,3例(11%)患者调整后置镜成功,平均置镜时间(37±9)s。与T1时比较,T3～T5时患者的HR减慢,T2、T6时MAP升高,T4时降低,T2～T6时PaO2均升高,T5时PaCO2升高(P<0.05或P<0.01)。ASAⅢ或Ⅳ级患者术中严重低氧血症、高血压或低血压、心律失常发生率均高于ASAⅡ级患者(P<0.05),ASAⅡ级患者和ASAⅢ或Ⅳ级患者的术后咽喉痛及烧灼感的发生率差异无统计学意义。结论在静脉全麻下,使用硬质支气管镜外套充气套囊控制呼吸,可安全应用于呼吸道微创手术。Objective To evaluate the anaesthesia methods and the managements of ventilation in the micro-operations of the respiratory tract under video-assisted rigid bronchoscope. Methods After general induction, 27 patients（ASA Ⅱ-Ⅳ） needing air tube operation, were inserted the rigid bronchoscope with a homemade cuff, using IPPV with hand. HR, MAP, PaO2 and PaCO2 were recorded before anaesthesia（T1 ）, inserting rigid bronchoscope（T2）, 15 min（T3）, 30 min（T4 ）, 60 min（T5） after operation and 30 min （T6） after extubation. In addition, the degree of satisfactory and the rate of the side effects in perioperation and postoperation of patients（including ASA grade I]- IV） should be recorded. Results The rigid bronchoscopes were placed satisfactorily in 24 patients （occupied 89%）, and the another 3 patients（occupied 11%） had the same result after the rigid bronchoscope adjusted. The average time for inserting rigid bronchoscope was （37 ± 9） seconds. Compared with T1, HR descended at T3-Ts, MAP ascended at T2 and T6, but descended at T4, PaO2 was highed at T2-T6 ,and PaCO2 ascended at T5 （P〈0.05 or P〈0. 01）. The patients ASA Ⅲ or Ⅳ had higher incidence of hypoxemia, hypertension, hypotension and arrhythmia than those of patients ASA Ⅱ （P（0. 05）,and the incidence of sore throat had no sense in statistics between two groups. Conclusion In total intravenous anaesthesia, using the rigid bronchoscope with a homemade cuff to control the ventilation in the micro-operations of the airtube is safe.

关 键 词：静脉麻醉 硬质支气管镜 套囊 微创手术 

分 类 号：R614[医药卫生—麻醉学]