喉罩联合T型密封接头通气在新生儿无痛纤维支气管镜诊治中的临床观察  

he Application of Improved Laryngeal Mask in Fiberoptic Bronchoscopy in Newborns

作　　者：夏氢[1] 李秀泽[1] 张永洪[1] 李卫[1] 杨懿琳[1] 谢燕斌[1] 

机构地区：[1]绵阳市中心医院麻醉科,四川绵阳621000

出　　处：《华西医学》2013年第7期1039-1041,共3页West China Medical Journal

基　　金：四川省卫生厅科研课题(080218)~~

摘　　要：目的评价喉罩联合T型密封接头通气在新生儿无痛纤维支气管镜(纤支镜)诊治中的临床效果。方法对2010年3月-2012年10月收治的33例拟行纤支镜诊治的新生患儿,分为喉罩组(Ⅰ组)和常规组(Ⅱ组),两组患儿在术前半小时均静脉注射咪唑安定0.2～0.3 mg/kg基础上,Ⅰ组静脉注射枸橼酸芬太尼3～5μg/kg,置入喉罩联合T型密封接头通气下行纤支镜诊治;Ⅱ组常规表面麻醉下行纤支镜诊治。分析术前(T1)、通过声门(T2)、诊治中(T3)、检查后(T4),脉搏血氧饱和度(SpO2)、心率(HR)的变化情况、纤支镜从T型密封接头入口或鼻孔到通过声门的时间、镜检时间、支气管肺泡灌洗次数、镜检期间不良反应(呛咳、憋气、肢体运动、呼吸道损伤)及麻醉满意度(由内镜医师评价)。结果Ⅰ组与Ⅱ组比较,T1、T4时间点SpO2、HR差异无统计学意义,T2、T3时间点SpO2<85%、HR<100次/min的发生率Ⅰ组与Ⅱ组比较差异有统计学意义(P<0.01);纤支镜从T型密封接头入口或鼻孔到通过声门时间差异无统计学意义(P>0.05);Ⅱ组镜检时间短于Ⅰ组,支气管肺泡灌洗次数少于Ⅰ组;Ⅰ组不良反应低于Ⅱ组,麻醉满意度高于Ⅱ组(P<0.05)。结论喉罩联合T型密封接头通气在新生儿无痛纤支镜诊治气道管理安全有效可行,医师能从容操作。Objective To evaluate the clinical effect and safety of improved laryngeal mask airway for fiberoptic bronchoscopy in neonates.Methods We retrospectively analyzed the clinical data of 33 children who underwent fiberoptic bronchoscopy in our hospital between March 2010 and October 2012.The improved laryngeal mask was inserted and controlled respiration was performed during the period of fiberoptic bronchoscopy in Group ？.Fiberoptic bronchoscopy was carried out under surface anesthesia in routine inspection group（Group ？）.The heart rate（HR） and pulse oxygen saturation（SpO2） were recorded before,during and after the fiberoptic bronchoscopy.The duration of inspection and frequency of bronchoalveolar lavage was also recorded.The side effects such as irritating cough,breathlessness,the movement of limbs and the satisfaction of doctors were observed.Results The SpO2 after fiberoptic bronchoscopy of the two groups were significantly higher than those before fiberoptic bronchoscopy（P0.01）.The incidence of SpO2lower than 85% and HR lower than 100 bpm was lower in group ？ than that in group ？（P0.05）.The duration of inspection and frequency of bronchoalveolar lavage in group？ were significantly less than those in group ？（P0.05）.There was less irritating cough in group ？ than in group ？（P0.05）.The satisfaction of doctors was significantly higher in group ？ than that in group ？（P0.05）.Conclusion It is safe and effective to perform painless fiberoptic bronchoscopy by controlled ventilation with laryngeal mask airway and T-seal adapter in neonates.

关 键 词：喉罩 T型密封接头 新生儿 无痛纤维支气管镜 

分 类 号：R722.1[医药卫生—儿科]