容量控制机控通气下硬支气管镜小儿气管异物取出术的效果  

Effect of volume-controlled ventilation on removal of airway foreign body in children by rigid bronchoscope

作　　者：王玉霞[1] 孙孟琳 王涛[1] 刘杰[1] 张军辉[2] 杨波 任洁 杜佳颖 姜丽华[1] WANG Yu-xia;SUN Meng-lin;WANG Tao;LIU Jie;ZHANG Jun-hui;YANG Bo;REN Jie;DU Jia-ying;JIANG Li-hua(Department of Anesthesiology,the Third Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of ear-nose-throat,the Third Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Anesthesiology,Chest Hospital of Henan Province,Zhengzhou 450014,China)

机构地区：[1]郑州大学第三附属医院麻醉科,郑州450052 [2]郑州大学第三附属医院耳鼻喉科,郑州450052 [3]河南省胸科医院麻醉科,郑州450014

出　　处：《医药论坛杂志》2023年第5期17-21,共5页Journal of Medical Forum

基　　金：2020年度河南省医学科技攻关计划联合共建项目(LHGJ20200459)。

摘　　要：目的评价容量控制机控通气下硬支气管镜小儿气管异物取出术的效果。方法择期于郑州大学第三附属医院行气管异物取出术患儿80例,随机分为两组:机控通气组(C组,n=40),自主呼吸组(S组,n=40)。两组分别有37例(C组)38例(S组)完成研究。诱导时均使用舒芬太尼、丙泊酚静注,C组诱导时给予顺式阿曲库铵0.15 mg/kg,接麻醉机控制呼吸;S组保留自主呼吸,两组均使用丙泊酚、瑞芬太尼泵注维持麻醉。记录两组患儿手术时间;术中不良事件(SpO_(2)下降情况、手术暂停、屏气、呛咳及喉、支气管痉挛)发生情况;术毕即刻P_(ET)CO_(2)值;手术医生满意度。结果两组患儿手术时间差异无统计学意义。C组屏气、呛咳及喉、支气管痉挛0例,与S组相比差异有统计学意义(P<0.05)。C组患儿SpO_(2)下降发生率、手术暂停率低于S组(P<0.001)。两组患儿术毕即刻P_(ET)CO_(2)值C组低于S组(P<0.05)。手术医生满意度比较C组高于S组(P<0.001)。结论容量控制机控通气应用于硬支气管镜小儿气管异物取出术是安全的。与保留自主呼吸的麻醉方式相比,术中患儿不良事件发生少,更便于手术医生操作,为患儿手术及麻醉提供了更高的安全保障。Objective To evaluate the effect of volume-controlled ventilation on the removal of airway foreign body in children by rigid bronchoscope.Methods Eighty children undergoing rigid bronchoscopy for foreign body removal were randomly divided into two groups:machine-controlled ventilation group(Group C,n=40)and spontaneous breathing group(Group S,n=40).In the two groups,37 cases(group C)and 38 cases(group S)completed the study.Sufentanil and propofol were given intravenously during induction.Group C was given cisatracurium 0.15 mg/kg during induction and connected to an anesthesia machine to control breathing;group S retained spontaneous breathing,and both groups were given propofol and remifentanil pumps to maintain anesthesia.Record the operation time of the two groups of children;the occurrence of adverse events(SpO_(2)drop,operation pause,breath-holding,coughing,and laryngeal and bronchospasm)during the operation;P_(ET)CO_(2)value immediately after the operation;surgeons satisfaction with anesthesia.Results There was no significant difference in operation time between the two groups of children.There were O cases of breath-holding,coughing,larynx and bronchospasm in group C,which was significantly different from group S(P<0.05).The incidence of SpO_(2)decline and operation pause rate in group C were lower than those in group Sthe P_(ET)CO_(2)value in group C were lower than those in group S(P<0.05).The satisfaction of surgeons in group C was higher than that in group S(P<0.001).ConclusionThe volume-controlled ventilation is safe for airway foreign body removal in children by rigid bronchoscope.Compared with the anesthesia that preserves spontaneous breathing,this anesthesia mode has fewer adverse events during the operation,provides better-operating conditions for the surgeon,and provides a higher safety guarantee for the childs operation and anesthesia.

关 键 词：顺阿曲库铵 气管异物 硬支气管镜 控制通气 麻醉 

分 类 号：R726.1[医药卫生—儿科]