喉罩全身麻醉在纤维支气管镜引导下小儿经皮扩张气管切开术的应用  

Application of laryngeal mask general anesthesia in pediatric percutaneous dilatational tracheostomy guided by fiberbronchoscope

作　　者：王磊[1] 王少超 胡卫东[1] 昝云雷 李全德 Wang Lei;Wang Shaochao;Hu Weidong;Zan Yunlei;Li Quande(Department of Anesthesiology,Affiliated Children’s Hospital,Shandong University(Ji’nan Children’s Hospital),Ji’nan 250022,China;Department of Anesthesiology,Affiliated Shandong Provincial Maternal&Children’s Healthcare Hospital,Qingdao University,Ji’nan 250014,China)

机构地区：[1]山东大学附属儿童医院(济南市儿童医院)麻醉科,济南250022 [2]青岛大学附属山东省妇幼保健院麻醉科,济南250014

出　　处：《临床小儿外科杂志》2025年第2期172-178,共7页Journal of Clinical Pediatric Surgery

基　　金：济南市卫生健康委员会科技计划项目(2023-2-152)。

摘　　要：目的探讨喉罩全身麻醉在纤维支气管镜(简称纤支镜)引导下小儿经皮扩张气管切开术中的应用效果。方法回顾性分析2019年6月至2023年9月在山东大学附属儿童医院住院期间行经皮扩张气管切开术患儿的临床资料。术前经超声评估小儿甲状腺位置及颈部血管走行,选择合适的穿刺入路并标记穿刺点,全身麻醉后使用喉罩控制呼吸以保障患儿通气,喉罩置入成功后由纤支镜引导完成经皮扩张气管切开术。统计并分析患儿一般情况、麻醉方案、通气模式、手术操作、生命体征及不良事件发生情况等。结果共40例患儿纳入分析,均安全顺利完成手术,手术时间(35±9)min,麻醉时间(41±9)min。均成功置入喉罩,患儿均采用压力控制呼吸,吸气峰压12~20 cmH2O。在纤支镜进入气道检查时气道压力有不同程度升高,潮气量略有降低,但生命体征维持稳定,围手术期不良事件发生率为15%(6/40),主要为胃肠胀气和低氧血症。结论小儿经皮扩张气管切开术围手术期麻醉管理风险高,喉罩全身麻醉可为患儿提供有效的通气和稳定的麻醉深度,维持患儿术中生命体征平稳,确保纤支镜引导下小儿经皮扩张气管切开术安全、顺利完成,值得临床推广。Objective To explore the efficacy of laryngeal mask general anesthesia during percutaneous dilatational tracheostomy guided by fiberbronchoscope in children.Methods Retrospective analysis of medical records was performed for 40 hospitalized children undergoing percutaneous dilatational tracheostomy at Affiliated Children’s Hospital of Shandong University from June 2019 to September 2023.Preoperative ultrasonic assessment was performed for evaluating thyroid position and following the course of anterior tracheal vessels.This aided in selecting an appropriate puncture route and marking the puncture point.After general anesthesia,a laryngeal mask was utilized for respiratory control to ensure ventilation and percutaneous dilatational tracheotomy performed guided by fiberbronchoscope after successful laryngeal mask placement.Statistical analyses were conducted for general profiles,anesthesia protocols,ventilation mode,surgical procedures,vital signs and adverse events.Results All procedures were performed smoothly and safely.The average surgical duration was(35±9)min and average anesthesia duration(41±9)min.Laryngeal masks were all successfully placed and pressure controlled breathing was achieved with peak inspiratory pressures of(12-20)cmH2O.There was a variable elevation in airway pressure and a slight declined in tidal volume during flexible bronchoscopy.Vital signs remained stable.The incidence of adverse events during perioperative period was 15%.It was primarily attributed to gastrointestinal distension and hypoxemia.Conclusions Pediatric percutaneous dilatational tracheostomy presents a high risk in terms of perioperative anesthesia management.Laryngeal mask ventilation under general anesthesia can effectively provide ventilation and maintain a stable depth of anesthesia.This approach ensures a smooth progression of the procedure while maintaining the stability of vital signs.It enhances the operative safety and is worthy of wider clinical applications.

关 键 词：喉罩 麻醉 全身 纤维支气管镜 经皮扩张气管切开术 儿童 

分 类 号：R726.1[医药卫生—儿科]