儿童喉乳头状瘤光动力治疗的麻醉管理  

Anesthesiamanagementof photodynamic therapy for juvenile-onsetlaryngeal papilloma

作　　者：钟坤根 朱琳[1] 房晓燕 王新[1] 王晓燕[1] ZHONG Kungen;ZHU Lin;FANG Xiaoyan;WANG Xin;WANG Xiaoyan(Department of Anesthesiology,Fourth Medical Center of PLA General Hospital,Beijing 100048,China)

机构地区：[1]解放军总医院第四医学中心麻醉科,北京100048

出　　处：《转化医学杂志》2021年第5期298-301,共4页Translational Medicine Journal

摘　　要：目的总结局部给药光动力疗法治疗儿童喉乳头状瘤的麻醉管理,为临床麻醉提供经验。方法对45例行支撑喉镜下局部给药光动力疗法治疗喉乳头状瘤的患儿,采用静吸复合气管插管全身麻醉联合间断通气技术,记录入室(T0)、插管后5 min(T1)、置入支撑喉镜后5 min(T2)、敷药后5 min(T3)、照射后5 min(T4)、拔管后5 min(T5)的HR、MAP、SpO_(2)、EtCO_(2),并统计手术时间、麻醉时间、苏醒时间及并发症。结果所有患儿均顺利完成麻醉及手术治疗。手术时间为(235.9±32.7)min,麻醉时间为(260.3±36.1)min,拔管时间为(6.7±5.2)min。与T0相比,T3、T4的HR、MAP均降低,T5的SpO_(2)降低,P<0.05,差异有统计学意义。术中EtCO_(2)值维持在30~40 mmHg。术后1 d疼痛视觉模拟评分(VAS)为1~2分。术后57%(26例)患儿口咽分泌物明显增多。1例患儿拔管后10 min出现气道水肿呼吸困难再次插管后入住ICU。1例气管切开患儿术中间断通气反复插管出现瘤体脱落阻塞气道,迅速夹出瘤体后缓解。结论气管插管联合间断通气技术可安全、有效用于局部给药光动力疗法治疗儿童喉乳头状瘤。Objective To study the anesthesia management of photodynamic treatment by topical drug for juve‐nile-onset laryngeal papilloma and provide new strategy for clinical anesthesia.Methods Forty-five children who under‐went photodynamic therapy by topical drug under supporting laryngoscope to treat juvenile-onset laryngeal papilloma were treated with intravenous-inhalation general anesthesia combined with tracheal intubation and intermittent ventila‐tion.HR,MAP,SpO_(2)and EtCO_(2)were recorded at the following time points:entering the operating room(T 0),5 min after trachealintubation(T 1),5 min after inserting the support laryngoscope(T 2),5 min after topical drugs(T 3),5 min after la‐ser irradiation(T 4),and 5 min after tracheal extubation(T 5).The duration of operation and anesthesia,recovery time and complications were monitored.Results Anesthesia and operation were successfully completed in all cases.The average operation time was(235.9±32.7)min,the average anesthesia time was(260.3±36.1)min,and the average recovery time was(6.7±5.2)min.The HR,MAP at T 3 and T 4 decreased(P<0.05)and the SpO_(2)at T 5 dipped(P<0.05)when compared with T 0.The EtCO_(2)level was maintained at 30~40 mmHg during operation.The visual analogue scale(VAS)of pain was 1~2 one day after operation.And 57%of postoperative cases had significantly increased oropharyngeal secretions.One case developed airway edema and dyspnea 10 min after extubation was transferred to the ICU after reintubation.One case with tracheotomy developed airway obstruction because of tumor shedding,which was due to repeated intermittent ventilation and intubation was relieved by removing the tumor quickly.Conclusion Tracheal intubation combined with intermittent ventilation technology can be safely and effectively used in the anesthesia process of photodynamic therapy bytopical drugfor juvenile-onset laryngeal papilloma.

关 键 词：儿童喉乳头状瘤 光动力治疗 麻醉 

分 类 号：R726.1[医药卫生—儿科] R739.65[医药卫生—临床医学]