机械控制通气下经纤支镜氩气刀切除中心气道器质性病变  

Efficacy of mechanical ventilation during argon plasma coagulation for resecting central airway obstruction lesions via flexible bronchoscope

作　　者：张春宝[1] 钟军[2] 陆卫忠[3] 门小光[4] 田志强[1] 

机构地区：[1]解放军第303医院急诊科,广西南宁530021 [2]解放军第303医院麻醉科,广西南宁530021 [3]解放军第303医院呼吸科,广西南宁530021 [4]解放军第303医院耳鼻喉科,广西南宁530021

出　　处：《中国内镜杂志》2012年第7期689-692,共4页China Journal of Endoscopy

摘　　要：目的评价全身麻醉机械控制通气下经纤支镜氩气刀切除中心气道器质性病变的效果及可行性。方法 34例中心气道器质性病变患者,在快速诱导全身麻醉下插入三通喉罩气道(TLMA),在机械控制通气下经纤支镜氩气刀切除中心气道器质性病变。术中连续监测收缩压(SP)、舒张压(DP)、心率(HR)和脉搏氧饱和度(SPO2),记录麻醉前5min(T0)、手术开始(T1)、手术5min(T2)、10min(T3)和术毕(T4)时的SP、DP、HR和SPO2。于T0、T2、T3和T4时采集桡动脉血行血气分析。记录手术时间,通气时间和手术结果。结果 34例患者共接受经纤支镜中心气道器质性病变切除术45例次,全部手术均顺利完成。手术时间15～52(24±8)min,通气时间35～65(41±10)min。术中血压、心率平稳。TLMA通气后PCO2、PO2、O2sat明显改善(P<0.05)。术后无明显并发症。结论全身麻醉机械控制通气下经纤支镜氩气刀切除中心气道器质性病变的效果好,并发症少。[ Objective ] To evaluate the efficacy and safety of mechanical ventilation during argon plasma coagu- lation for resecting central airway obstruction lesions via the flexible bronchoscope under general anesthesia. [Methods] 34 patients （ASA class Ⅰ -Ⅲ ） aged 18-84yrs undergoing argon plasma coagulation for resecting cen- tral airway obstruction lesions via the flexible bronchoscope under general anesthesia with mechanical ventilation. SP02, SP, DP and HR were continuously monitored during anesthesia and measured at 5 min after entering the surgery room （TO）, immediately after the bronchoscope entering the glottis（T1 ）, 5min and 10min after the broncho- scope entering the glottis （T2, T3） and at the immediately after the bronchoscope extubating the glottis （T4）. Blood samples were taken from radial artery at TO, 2-4 for blood gas analysis. [ Results ] 34 patients received 45 argon plasma coagulation procedures. The operation time was 15-52min and the ventilation time was 35-65 min. Com- pared with TO, the PCO2, PO2 and O2sat was obviously improved after TLMA ventilation （P 〈0.05）. The patients a- woke in 30 min and the TLMA was removed. No complications were observed in all cases after operation. [ Conclu- sion ] Patients underwent argon plasma coagulation for resetting central airway obstruction lesions via the flexible bronchoscope under general anesthesia with mechanical ventilation exert good efficiency with fewer complications.

关 键 词：机械控制通气 全身麻醉 中心气道阻塞 氩气刀 支气管镜 

分 类 号：R655.3[医药卫生—外科学]