小儿纵隔肿瘤活检的麻醉处理  

Anesthesia management in children with mediastinal tumors undergoing biopsy

作　　者：陈丽丽[1] 张建敏[1] 王芳[1] 

机构地区：[1]首都医科大学附属北京儿童医院麻醉科,100045

出　　处：《北京医学》2015年第8期785-788,共4页Beijing Medical Journal

摘　　要：目的总结小儿纵隔肿瘤活检手术麻醉管理的临床经验。方法对1例纵隔肿瘤患儿行局部麻醉下活检术,因患儿不合作,故实施气管内插管全麻。对此例患儿术前评估、麻醉方法的选择及并发症处理进行总结分析。结果本例3岁患儿,因发现纵隔占位性病变15 d入院。自患病以来,家长自诉未见明显呼吸困难,可平躺。胸部CT示前纵隔占位,气管受压。患儿静脉诱导插管后,出现潮气量降低、气道压增高,PETCO2波形消失。考虑全麻后发生肿瘤压迫气道梗阻,予改变体位为右侧卧位后症状缓解,后于右侧卧位完成穿刺活检术。结论此类患儿的麻醉风险较高,其术前评估、麻醉方式选择和围术期管理十分重要,避免呼吸道梗阻、保持循环稳定是儿童纵隔肿瘤活检手术成功的重要保证。Objective To summarize clinical experience of anesthesia management for mediastinum tumor in children. Methods One child with mediastinum tumor was given biopsy under local anesthesia. Because the patient was not cooperative, the general anesthesia with endotracheal intubation was performed. Summary and analysis were carried out on preoperative assessment, choice of anesthesia methods and complications of treatment. Results The current pa- tient was 3 years old, hospitalized for 15 days since the identification of a mediastinal mass. According to the patient＇ s parents, the patient did not experience difficulty in breathing and was able to lie flattly. Chest CT showed an anterior medi- astinal mass with tracheal compression. After intravenous induction and intubation, the patient started to have decreased tidal and increased airway pressure, along with disappeared PETCO2wave. We considered that it might be due to airway ob- struction by mass compression, which was exacerbated by general anesthesia. Accordingly, the patient was adjusted to the right lateral position and subsequently the symptoms were significantly relieved. As such, the rest of the biopsy operation was performed with the patient at the right lateral position. Conclusion The anesthetic risks are high in patients with a mediastinal mass and therefore pre-surgical evaluation, method of anesthesia and perioperative management are critical. Prevention of airway obstruction and maintenance of cardio-vesicular stability are important guarantees to successful biop-sy of a mediastinal mass.

关 键 词：小儿 纵隔肿瘤 活检 全身麻醉 

分 类 号：R726.1[医药卫生—儿科] R734.5[医药卫生—临床医学]