经胸腔镜新生儿食管闭锁合并食管气管瘘手术的麻醉管理  

Anesthesia management of the operation of esophageal atresia combined with esophagotracheal fistula in neonates undergoing thoracoscopic surgery

作　　者：赵海涛[1] 段国辰 石磊[1] 王亚芳[3] 张琦 陈志国[2] ZHAO Haitao;DUAN Guochen;SHI Lei(Department of Anesthesiaology,Hebei Provincial Children’s Hospital,Hebei,Shijiazhuang 050011,China;不详)

机构地区：[1]河北省儿童医院麻醉科,石家庄市050011 [2]河北省儿童医院胸外科,石家庄市050011 [3]河北省儿童医院耳鼻咽喉科,石家庄市050011

出　　处：《河北医药》2021年第1期74-77,共4页Hebei Medical Journal

摘　　要：目的探讨经胸腔镜新生儿食管闭锁合并食管气管瘘手术的最佳麻醉管理方案。方法回顾性分析2013年4月至2020年2月于胸外科接受经胸腔镜食管端端吻合+食管气管瘘结扎术的新生儿56例,ASAⅢ级。患儿均采用以瑞芬太尼与七氟烷为主的静吸复合麻醉,以氯胺酮、芬太尼、罗库溴铵诱导行机械通气,手术过程中定时监测血气分析,调节呼吸参数,必要时经中心静脉导管微量泵输注血管活性药物维持循环平稳。分析患儿麻醉管理方式与手术过程中的生命体征、呼吸参数、并发症等情况。结果56例患儿均顺利完成手术,麻醉过程平稳,术毕保留气管插管、胃管、动静脉插管安返NICU,无麻醉意外与并发症。与T0比较,T1时点患儿心率、血氧饱和度、平均动脉压和呼吸末二氧化碳差异无统计学意义(P>0.05)。与T0时比较,T2、T3时心率、平均动脉压和呼吸末二氧化碳明显下降,差异有统计学意义(P<0.05)。与T0比较,T1时pH值、PaO2和PaCO2比较,差异无统计学意义(P>0.05)。与T0时比较,T2、T3时PaO2下降和PaCO2显著升高,差异有统计学意义(P<0.05)。与A组比较,B组患儿术后机械通气时间延长,预后较差(P<0.05)。结论以瑞芬太尼与七氟烷为主、行机械通气的静吸复合麻醉方式,在严格控制气道峰压的情况下可安全应用于胸腔镜下新生儿食管闭锁合并食管气管瘘手术的麻醉。Objective To investigate the best anesthesia scheme for thoracoscopic surgery in neonates with esophagealatresia combined with esophagotracheal fistula.Methods The clinical data about 56 neonates who underwent thoracoscopic end-to-end esophagogastrostomy combined with esophagotracheal fistula ligation were retrospectively analyzed.All the 56 patients underwent intravenous combined anesthesia with remifentanil and sevoflurane,mechanical ventilation was induced by ketamine,fentanyl,and rocuronium.The blood gas analysis was periodically monitored during the operation to adjust respiratory parameters,if necessary,intravenous micropump infusion of vasoactive drugs wee used to maintain stable circulation.The anesthesia management mode and vital signs during the operation,respiratory parameters,and complications were observed and analyzed.Results The operations of the 56 patients were successfully completed,and the anesthesia process was stable,with tracheal intubation,gastric tube,and arteriovenous intubation,thenthese patients returned to NICU safely after the operation,without anesthesia accidents and complications.As compared with those in T0,the heart rate,blood oxygen saturation,mean arterial pressure and respiration end carbon dioxide levels were significantly decreased at T2 and T3(P<0.05),however,the pH,PaO2 and PaCO2 were not significantly changed(P>0.05).Conclusion The combination of intravenous and inhalation anesthesia with remifentanil and sevoflurane as well as mechanical ventilation can be safely applied for the the anesthesia of neonatal esophageal atresia combined with esophagotracheal fistula under thoracoscopy.

关 键 词：食管闭锁并食管气管瘘 胸腔镜 新生儿 麻醉 

分 类 号：R614.2[医药卫生—麻醉学]