颈部烧伤瘢痕挛缩患儿的气道管理  

Airway management in children with post-burn contracture scar of the neck

作　　者：毛豪丽[1] 徐辉[1] 孙宇[1] 刘春芳[1] 方舒东[1] MAO Haoli;XU Hui;SUN Yu;LIU Chunfang;FANG Shudong(Department of Anesthesiology,Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200011,China)

机构地区：[1]上海交通大学医学院附属第九人民医院麻醉科,上海市200011

出　　处：《组织工程与重建外科》2021年第6期493-496,共4页Journal of Tissue Engineering and Reconstructive Surgery

摘　　要：目的探讨颈部烧伤瘢痕挛缩患儿的麻醉和困难气道管理。方法回顾性分析60例择期行全麻手术的颈部烧伤瘢痕挛缩患儿,分为七氟烷(A组)和艾司氯胺酮组(B组)。两组均静注右美托咪定1μg/kg,A组面罩吸氧5 L/min+七氟烷6%~8%,B组静脉注射艾司氯胺酮0.5 mg/kg,患者意识消失后,辅以气管内和咽喉区表面麻醉。患者均保留自主呼吸,采用纤维支气管镜经鼻腔气管插管。插管过程中,根据患者反应追加艾司氯胺酮或吸入七氟烷维持麻醉深度。观察并记录各组的成功插管例数、插管时间和插管过程中有无呛咳憋气、体动、喉痉挛等并发症。结果所有患儿均在纤维支气管镜下经鼻成功气管插管。插管时间A组长于B组(P<0.05);插管过程中,呛咳憋气、体动的发生率A组高于B组(P<0.05),两组均无喉痉挛发生。结论右美托咪定复合七氟烷或右美托咪定复合艾司氯胺酮,辅以完善的表面麻醉,均可完成小儿颈部瘢痕挛缩患者困难气道的纤维支气管镜插管,右美托咪定复合艾司氯胺酮可使插管过程更短、更平稳。Objective To investigate anesthetic and difficult airway management in children with post-burn contracture scar of the neck.Methods This retrospective study included 60 patients with post-burn scar contracture of the neck,who were scheduled for elective plastic surgery under general anesthesia,and the patients were divided into the sevoflurane group(Group A)and the esketamine group(Group B).1μg/kg dexmedetomidine were administration intravenously in both groups.Patients in group A were given 6%-8%sevoflurane inhalational anesthesia plus 5 L/min oxygen inhalation via mask.Group B patients received 0.5 mg/kg of esketamine.After the patients lost conscious,they were treated with intratracheal and laryngopharyngeal topical anesthesia,the spontaneous breathing was reserved in both groups,and intubated with fiberoptic nasal intubation.During intubation,the depth of anesthesia was maintained by adding administration esketamine or sevoflurane inhalation.The number of success intubation,intubation time and relative complications,including coughing,limb movement,laryngospasm were observed and recorded in all patients.Results The children in both groups were successfully intubated through fiberoptic nasal intubation.The intubation time of group A was longer than that of group B(P<0.05).During intubation,the incidence of coughing,suffocating and body movement in group A was higher than that in group B(P<0.05),and no laryngospasm occurred in both groups.Conclusion Dexmedetomidine plus sevoflurane inhalation or administration esketamine,combined with sufficient topical anesthesia can accomplish the difficult airway fiberoptic intubation in children with scar contracture of the neck,dexmedetomidine plus esketamine combination has shorter intubation time and better sedation.

关 键 词：颈部瘢痕挛缩 头部伸展受限 气道管理 纤维支气管镜插管 小儿 

分 类 号：R619[医药卫生—外科学]