不同通气模式下小儿气道异物取出术的效果  

Comparison of clinical efficacy of different ventilation modes for removal of airway foreign bodies in pediatric patients

作　　者：肖颖[1] 段娜[1] 王伟[1] 温健[1] 景桂霞[1] 王强[1] XIAO Ying DUAN Na WANG Wei WEN Jian JING Guixia WANG Qiang(Department of Anesthesiology, First Affiliated Hospital of Xi ＇ an Jiaotong University ,Xi ＇ an 710061, China)

机构地区：[1]西安交通大学医学院第一附属医院麻醉科,西安710061

出　　处：《山西医科大学学报》2017年第6期619-624,共6页Journal of Shanxi Medical University

基　　金：西安交通大学临床新技术资助项目(XJLS-2015-293);陕西省自然科学基金资助项目(2016JM8131)

摘　　要：目的比较不同通气模式下小儿气道异物取出术的麻醉效果和安全性。方法 80例在硬直支气管镜下行气道异物取出术的小儿患者,随机分为自主呼吸组和控制呼吸组,每组40例。自主呼吸组麻醉诱导采用右美托咪定负荷剂量4μg/kg,同时复合丙泊酚以150μg/(kg·min)的速度持续泵注,维持使用右美托咪定0.8-1μg/(kg·h)速度泵注,丙泊酚以80-120μg/(kg·min)的速度持续泵注,根据呼吸情况调整剂量,全程保留患儿自主呼吸;控制呼吸组麻醉诱导采用丙泊酚3-5mg/kg,瑞芬太尼2μg/kg和琥珀胆碱2 mg/kg,维持采用丙泊酚以150-200μg/(kg·min),瑞芬太尼0.05μg/(kg·min)的速度持续泵注,间断推注琥珀胆碱2 mg/kg。记录入手术室后(T_0)、诱导完毕(T_1)、置入硬直喉镜后(T_2)、置入喉镜后10 min(T_3)、退出喉镜时(T_4)、返回病房(T_5)患儿的MAP、HR、SpO_2、P_(ET)CO_2、BIS值。记录一次性置入硬直喉镜成功率、手术时间、麻醉苏醒时间、异物成功取出率、围术期不良反应包括喉痉挛、心律失常、体动、屏气和呛咳、苏醒期躁动、低氧血症、气胸等的发生率。结果与T_0比较,控制呼吸组患儿在T_1-T_5的HR无显著降低(P>0.05),自主呼吸组患儿在T_1-T_5的HR显著降低(P<0.05);与控制呼吸组相比,自主呼吸组患儿在T_1-T_5HR显著低于控制呼吸组(P<0.05)。与T_0比较,控制呼吸组患儿在T_1-T_4的MAP显著降低(P<0.05);与控制呼吸组相比,自主呼吸组患儿MAP在T_1-T_4显著高于控制呼吸组(P<0.05)。自主呼吸组患儿SpO_2在T_3显著高于控制呼吸组,而P_(ET)C0_2在T4显著低于控制呼吸组,BIS值在T_1-T_4显著低于控制呼吸组(P<0.05),自主呼吸组的麻醉苏醒时间显著长于控制呼吸组(P<0.05),自主呼吸组手术时间、苏醒后烦躁发生率以及术中低氧的发生率显著低于控制呼吸组(P<0.05),自主呼吸组麻醉效果显著优于控制呼吸组(P<0.05)。结论在小儿气道异物取出术中采�Objective To compare clinical anesthesia effects and safety of different ventilation modes for removal of airway foreign bodies in pediatric patients. Methods Eighty pediatric patients were randomly allocated to spontaneous breathing group（ n = 40） and controlled respiration group （n = 40 ）. The patients in spontaneous breathing group received dexmedetomidine at initial dose of 4 μg/kg and propofol at initial dose of 150 μg/（ kg .min） ,followed by continuous infusion of 0. 8 -1.0 μg/（kg ·h） 80 -120 μg/（ kg-rain）, respectively. The doses of dexmedetomidine and propfol were adjusted for reserving spontaneous breathing during the procedure. The pa- tients in controlled respiration group received propofol at initial dose of 3 -5 mg/kg,remifentanyl at initial dose of 2μg/kg and succi- nyleholine at initial dose of 2 mg/kg, followed by continuous infusion of 150 -200 μg/（ kg. min） ,0. 05 μg/（ kg. min） and intermittent infusion of 2 mg/kg, respectively. Mean arterial pressure （MAP） , heart rate （HR） , peripheral oxygen saturation （ SpO2 ） , PET CO2, bis- peetral index（BIS） were recorded at baseline value before anaesthesia（ TO ） ,after induction（T1 ） ,after insertion of rigid bronchoscope （T2 ）, at 10 min after insertion of rigid bronchoscope（ T3 ）, after the withdrawing of rigid bronehoscope （T4 ） and at the returning ward （ T5 ）. The success rate of first insertion of bronehoscope, the duration of the operation, the recovery time from anesthesia, the success rate of removal of foreign bodies and the condition for perioperative adverse events, such as laryngospasm, arhythmia, body movement, breathing hold,postoperative agitation,hypoxemia, pneumothorax were recorded. Results Compared with To, HR showed no signifi- cant decrease at T1 -Ts in controlled respiration group（ P 〉 0. 05 ） ,while HR decreased significantly at T1 -T5 in spontaneous breath- ing group（ P 〈 0.05）. Compared with controlled respiration group, HR was significantly

关 键 词：小儿 麻醉 气道异物 硬质支气管镜 通气模式 

分 类 号：R614[医药卫生—麻醉学]