CAJ | 학술논문

目的观察人工通气加持续气道正压(CPAP)的方法在小儿气管异物取出术中的临床效果,探讨其可行性和安全性.方法 60例在静脉复合全麻下行气管异物取出术的患儿,随机分为A组和B组,每组30例.A组采用人工通气加持续气道正压的通气方法,即在麻醉诱导完3 min置入支气管镜,经支气管镜侧孔连接麻醉机行人工通气,同时给予高流量(10～15 L/min)新鲜气流以保持持续气道正压;B组采用高频喷射通气(HFJV),频率为60～100 次/min.若术中SpO2＜90%,则退出支气管镜予面罩通气,氧合改善后再行取异物.入室后监测MAP、HR、ECG、SpO2和PETCO2,定时采血测定PaO2和PaCO2等.记录入室即时(T0)、入镜即时(T1)、人镜后5 min((T2)、入镜后10 min(T3)及术毕(T4)时MAP、HR、SpO2、PaO2和PaCO2值.观察两组不良反应发生情况,记录其退镜率和术毕插管率.结果两组患儿一般情况和MAP差异无统计学意义(P＞0.05).两组HR在麻醉后比入室时明显下降(P＜0.01),但差异无统计学意义(P＞0.05).两组SpO2和PaO2在麻醉后均比人室时明显升高(P＜0.01),同时A组PaO2在入镜后不同时段均明显高于B组(P＜0.05).两组PaCO2在入镜后逐渐升高,但A组升高幅度明显低于B组(P＜0.05或0.01).两组退镜率和插管率差异均无统计学意义(均P＞0.05),但B组总退镜和插管次数略高于A组.结论人工通气加持续气道正压的通气方法用于小儿气管异物取出术安全可行,可控性较好,呼吸功能影响小,值得推广.
목적 관찰인공통기가지속기도정압(CPAP)적방법재소인기관이물취출술중적림상효과,탐토기가행성화안전성.방법 60례재정맥복합전마하행기관이물취출술적환인,수궤분위A조화B조,매조30례.A조채용인공통기가지속기도정압적통기방법,즉재마취유도완3 min치입지기관경,경지기관경측공련접마취궤행인공통기,동시급여고류량(10～15 L/min)신선기류이보지지속기도정압;B조채용고빈분사통기(HFJV),빈솔위60～100 차/min.약술중SpO2＜90%,칙퇴출지기관경여면조통기,양합개선후재행취이물.입실후감측MAP、HR、ECG、SpO2화PETCO2,정시채혈측정PaO2화PaCO2등.기록입실즉시(T0)、입경즉시(T1)、인경후5 min((T2)、입경후10 min(T3)급술필(T4)시MAP、HR、SpO2、PaO2화PaCO2치.관찰량조불량반응발생정황,기록기퇴경솔화술필삽관솔.결과 량조환인일반정황화MAP차이무통계학의의(P＞0.05).량조HR재마취후비입실시명현하강(P＜0.01),단차이무통계학의의(P＞0.05).량조SpO2화PaO2재마취후균비인실시명현승고(P＜0.01),동시A조PaO2재입경후불동시단균명현고우B조(P＜0.05).량조PaCO2재입경후축점승고,단A조승고폭도명현저우B조(P＜0.05혹0.01).량조퇴경솔화삽관솔차이균무통계학의의(균P＞0.05),단B조총퇴경화삽관차수략고우A조.결론 인공통기가지속기도정압적통기방법용우소인기관이물취출술안전가행,가공성교호,호흡공능영향소,치득추엄.
Objective To observe the clinical effect of artificial ventilation combined continuous positive airway pressure(CPAP) with removal of tracheobronchial foreign bodies for children and to explore the possibility and security of the method. Methods 60 children with tracheobronchial foreign body, underwent total intravenous anesthesia ,were randomly divided into A group and B group. Each group had 30 cases. A group was given artificial ventilation with CPAP. The bronchofibroscope was connected to anesthesia machine with side hole after induction for 3 minutes,and high fresh gas flow(10 ～ 15L/min) was given to maintain continuous positive airway pressure. B group were given high frequency jet ventilation(HFJV) ,60 ～ 100 bpm. The mask ventilation was given in stand of bronchofibroscope when SpO2 ＜ 90% and until SpO2 improved. MAP, HR, ECG, SpO2, PaO2, PaCO2 were monitored and recorded at time points: T0 (entered operation room), T1 (beginning of bronchofibroscopy), T2 (5 min after bronchofibroscopy), T3 (10 min after bronchofibroscopy), T4 (end of operation). The side effects, the rate of fail to bronchofibroscopy and the rate of intubations after operation in two groups were observed and recorded. Results The HR of post-anesthesia in two groups significantly decreased than those at T0 (P ＜ 0.01), but no difference showed in HR between two groups(P ＞ 0.05). SpO2 and PaO2 of post-anesthesia in two groups significantly increased than those at T0 (P ＜0. 01) ,PaO2 at T1 ,T2 ,T3 in A group were significantly higher than those in B group(P ＜0.05). PaCO2 gradually increased after bronchofibroscopy in two groups ,and the values in A group was significantly lower than in B group(P ＜0.05 or 0. 01). There were no significant differences in the rates of fail to bronchofibroscopy and of intubations after operation between two groups, but the total number of B group was higher. Conclusion Artificial ventilation with CPAP for children with removal of tracheobronchial foreign bodies was safe and practical, and has a better controllability, a minor effect to respiratory function, deserve popularizing.