全身麻醉喉罩通气在小儿声门下狭窄纤维支气管镜介入手术中的应用研究  

Application of laryngeal mask controlled ventilation under general anesthesia in interventional surgery via fiberoptic bronchoscope for pediatric subglottic stenosis

作　　者：禹二友 向珍 吴磊 危思维 肖婷[1] 杜真[1] 王江平[1] Yu Eryou;Xiang Zhen;Wu Lei;Wei Siwei;Xiao Ting;Du Zhen;Wang Jiangping(Department of Anesthesiology,Hunan Children's Hospital,Changsha 410007,China)

机构地区：[1]湖南省儿童医院麻醉手术科,湖南省长沙市410007

出　　处：《临床小儿外科杂志》2021年第11期1038-1041,1047,共5页Journal of Clinical Pediatric Surgery

基　　金：湖南省自然科学基金青年基金项目(编号:2019JJ50295)。

摘　　要：目的探讨全身麻醉喉罩控制通气在小儿声门下狭窄纤维支气管镜介入手术中的应用效果。方法回顾性分析湖南省儿童医院2019年1月至2020年5月期间52例因声门下狭窄行经纤维支气管镜介入手术患者的相关临床资料。术中均采用全身麻醉喉罩控制通气方式,观察和记录患者入室后(T1)、麻醉诱导后(T2)、手术开始时(T3)、手术开始后15 min(T4)及手术结束时(T5)的心率、血氧饱和度、平均动脉压以及围术期不良事件发生情况,并进行统计学分析。结果52例均顺利、安全完成介入手术,其中13例出现至少1次围术期不良事件(包括10例次胃胀气,5例次气道痉挛,4例次低氧血症)。平均手术时长(63.08±31.58)min,平均麻醉诱导时长(6.93±1.06)min。T1至T5各时间点HR、MAP水平差异均无统计学意义(P>0.05);T1至T5各时间点SpO_(2)水平差异有统计学意义(P<0.001),并于手术开始时(T3)达到最高水平。结论小儿声门下狭窄纤维支气管镜介入手术中采用全身麻醉喉罩控制通气,有利于提高患者氧储备和手术耐受能力,减少手术中不良事件的发生,具有较好的麻醉效果。Objective To explore the anesthetic effect and surgical safety of laryngeal mask controlled ventilation under general anesthesia during interventional surgery via fiberoptic bronchoscope for pediatric subglottic stenosis.Methods From January 2019 to May 2020,retrospective review was conducted for 52 children aged over 1 year old undergoing interventional surgery via fiberoptic bronchoscope for subglottic stenosis.General anesthesia was applied with laryngeal mask controlled ventilation.Clinical profiles and the changes of HR(heart rate),oxygen concentration(SpO_(2))and MAP(mean arterial pressure)at the timepoints of entering operating room(T1),completing induction(T2),starting operation(T3),15 min post-operation(T4)and end of operation(T5)were recorded.Results All procedures were completed successfully and at least one perioperative adverse event occurred in 13 cases.Mean operative duration was(63.08±31.58)min and mean anesthesia induction duration(6.93±1.06)min.No significant changes occurred in HR or MAP at the timepoints of T1-T5(P>0.05).The level of SpO_(2)changed markedly(P<0.001)and peaked at T3.Conclusion During interventional surgery via fiberoptic bronchoscopy,laryngeal mask controlled ventilation under general anesthesia may improve blood oxygen reserve,enhance surgical tolerance and reduce the occurrence of adverse events with better anesthesia effect and operative safety.

关 键 词：支气管镜检查 声门下狭窄 介入手术 喉罩 控制通气 儿童 

分 类 号：R768.1[医药卫生—耳鼻咽喉科] R767.44[医药卫生—临床医学]