小儿喉蹼患者麻醉诱导期的管理  

The anesthesia induction of pediatric patients with laryngeal web

作　　者：辛燕[1] 袁维秀[1] 郭英[1] 姜雨鸽[1] 张宏[1] 

机构地区：[1]解放军总医院麻醉手术中心,北京100853

出　　处：《北京医学》2013年第8期671-674,共4页Beijing Medical Journal

摘　　要：目的探讨小儿喉蹼患者的最佳麻醉管理。方法回顾性分析我院2009年12月至2013年3月经纤维喉镜、颈部X线或薄层CT确诊喉蹼的24例小儿患者的麻醉管理。结果所有患儿在术前均有不同程度的呼吸困难,手术的目的是解决通气问题。气管切开13例,其中6例术前先局麻下行气管切开后全麻,7例全麻插管后行气管切开;未行气管切开11例,直接在全麻下行气管内插管。诱导方式:快诱导经气管切口插管6例,快诱导经口插管7例,保留自主呼吸浅全麻诱导10例,1例先采用保留自主呼吸浅全麻诱导,第1次经口喉镜明视下插管失败后,面罩通气良好的情况下,改用快诱导,换管第3次插管成功。插管成功率:5例一次插管成功,10例两次插管成功,3例三次插管成功,平均插管时间12min。所有患儿均未出现诱导期缺氧,但有13例呼气末二氧化碳分压(PetCO2)明显偏高。所有患儿均安全完成麻醉诱导。结论术前充分的气道评估、完善的麻醉前准备及良好的团队协作是先天性喉蹼患儿围术期麻醉管理的关键。小儿喉蹼作为已预料的困难气道推荐选用保留自主呼吸浅全麻比较安全。Objective To explore the ideal anesthesia approach for pediatric laryngeal web surgery by retrospec- tively analyzing the collected cases. Methods Twenty-four cases diagnosed as laryngeal web by the fiber laryngoscopy, neck X-rays or thin slice CT between December 2009 and March 2013 were reviewed. Results All patients had different degrees of difficulty in breathing and received operation to solve the problem of ventilation. Among 13 children undergoing tracheotomy, 6 were performed general anesthesia after tracheotomy under local anesthesia, and 7 tracheotomy were taken after intubation. The rest 11 cases didn＇t undergo tracheotomy. Except for 6 cases with tracheal intubation through the tra- chea incision, 10 patients received shallow anesthesia under spontaneous breathing, and 7 had conventional general anes- thesia, and 1 case received deepened anesthesia under good mask ventilation and got successful intubation at the third time after intubation failure for the first time with shallow anesthesia and spontaneous breathing maintainence. Of 18 cases with tracheal intubation via the mouth, 5 children were performed tracheal intubation successfully for the first time, 10 children were attempted for intubation twice, and triple attempts to endotracheal intubation were needed in 3 cases, that intuba-tion lasted for an average of 12 min. Hypoxia were absent in all children in the induction period, but 13 cases of PetCO2 were significantly elevated. Conclusion Sufficient preoperative airway evaluation, perfect anesthesia preparation and good team work are the key points for pediatric laryngeal web anesthesia.

关 键 词：喉蹼 麻醉 诱导 

分 类 号：R726.1[医药卫生—儿科]