经鼻自制咽部给氧导管供氧对扁桃体手术患儿安全窒息时间的影响  

Effect of oxygen supply via transnasal self-made pharyngeal oxygen catheter on safe apnea time in pediatric patients undergoing tonsil surgery

作　　者：沈燕平[1] 殷利军[1] 李茹[1] 严海雅[1] Shen Yanpin;Yin Lijun;Li Ru;Yan Haiya(Department of Anesthesiology,Ningbo Women and Children′s Hospital,Ningbo 315012,China)

机构地区：[1]宁波市妇女儿童医院麻醉科,宁波315012

出　　处：《中华麻醉学杂志》2022年第5期586-590,共5页Chinese Journal of Anesthesiology

摘　　要：目的评价经鼻自制咽部给氧导管供氧对扁桃体手术患儿安全窒息时间的影响。方法择期全麻下行扁桃体手术患儿60例,ASA分级Ⅰ或Ⅱ级,年龄2~6岁,体重10~20 kg,性别不限,采用随机数字表法分2组(n=30):经鼻自制咽部给氧导管供氧组(NO组)和对照组(C组)。静脉注射咪达唑仑、丙泊酚、芬太尼和顺式阿曲库铵麻醉诱导后行面罩通气,当呼出气氧浓度(C_(ET)O_(2))达90%以上后移除面罩。NO组经鼻置入自制给氧导管至口咽部,连接湿化瓶并经其提供10 L/min的纯氧直至气管插管成功。患儿置入可视喉镜进行检查,以模拟困难气道。当SpO_(2)≤95%或安全窒息时间达600 s时停止窒息观察,快速气管插管成功后连接麻醉机行机械通气。记录安全窒息时间(移除面罩至SpO_(2)降到95%的时间)、停止面罩通气时C_(ET)O_(2)和停止面罩通气后SpO_(2)最低值。分别于入室时、窒息开始即刻和气管插管成功即刻,记录HR和MAP;于窒息开始即刻和气管插管成功即刻记录SpO_(2)和P_(ET)CO_(2),计算P_(ET)CO_(2)升高速度,同时测量胃窦部横截面积。记录置入自制咽部给氧导管时鼻腔出血、鼻腔干燥和术后咽部不适等的发生情况。结果与C组比较,NO组安全窒息时间延长,P_(ET)CO_(2)升高速度降低,停止面罩通气后SpO_(2)最低值升高,气管插管成功即刻HR增快,MAP、SpO_(2)和P_(ET)CO_(2)升高(P<0.05),停止面罩通气时C_(ET)O_(2)和各时点胃窦部横截面积差异无统计学意义(P>0.05)。NO组患儿置入自制咽部给氧导管时均未见鼻腔出血、鼻腔干燥和术后咽部不适等不良反应发生。结论经鼻自制咽部给氧导管供氧可延长扁桃体手术患儿安全窒息时间。Objective To evaluate the effect of oxygen supply via the transnasal self-made pharyngeal oxygen catheter on the safe apnea time in pediatric patients undergoing tonsil surgery.Methods Sixty American Society of Anesthesiologists physical statusⅠorⅡpatients of either sex,aged 2-6 yr,weighing 10-20 kg,scheduled for elective tonsillectomy under general anesthesia,were divided into 2 groups(n=30 each)using a random number table method:transnasal self-made pharyngeal oxygen catheter for oxygen supply group(group NO)and control group(group C).Anesthesia was induced with intravenous midazolam,propofol,fentanyl and cis-atracurium,and then ventilation was performed with a mask,and the mask was removed when the exhaled oxygen concentration(C_(ET)O_(2))reached more than 90%.In group NO,the self-made oxygen catheter was implanted into the oropharynx through the nose,and the 100%oxygen at 10 L/min was aspirated through the humidification bottle until the intubation was successful.In group C,the transnasal self-made oxygen catheter was not implanted,and the rest of the protocol was similar to those previously described in group NO.The visual laryngoscope was implanted to simulate difficult airways.When SpO_(2)≤95%or the safe apnoea time reached 600 s,the observation of apnea was stopped,and mechanical ventilation was started after successful rapid endotracheal intubation.The safe apnea time(from removing the mask until SpO_(2)decreased to 95%),value of C_(ET)O_(2)at the end of mask ventilation,and the minimum value of SpO_(2)after stopping mask ventilation were recorded.Heat rate and mean arterial pressure were observed and recorded on admission to the operating room,immediately after onset of apnea and immediately after successful endotracheal intubation.The SpO_(2),P_(ET)CO_(2)and cross-sectional area of gastric antrum were also recorded immediately after onset of apnea and immediately after successful endotracheal intubation,and the rate of increase in P_(ET)CO_(2)was calculated.The nasal bleeding,nasal dryness,postop

关 键 词：氧吸入疗法 呼吸暂停 低氧 儿童 

分 类 号：R726.1[医药卫生—儿科]