中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2013年
17期
1301-1304
,共4页
朱智瑞%盖春安%胡智勇%蒋一蕾%孙越峰
硃智瑞%蓋春安%鬍智勇%蔣一蕾%孫越峰
주지서%개춘안%호지용%장일뢰%손월봉
先天性喉软化症%麻醉管理%自主呼吸
先天性喉軟化癥%痳醉管理%自主呼吸
선천성후연화증%마취관리%자주호흡
Congenital laryngomalacia%Anesthetic management%Spontaneous respiration
目的 探讨先天性喉软化症手术的麻醉管理.方法 回顾性分析浙江大学医学院附属儿童医院2010年12月至2012年11月拟诊断为先天性喉软化症患儿27例,经鼻插入相应大小的气管导管至声门上方给氧,连续静脉输注丙泊酚和瑞芬太尼维持麻醉,保留患儿自主呼吸.记录麻醉时间、手术时间、瑞芬太尼最大输注速度；术中监测心电图、心率、平均动脉压(MAP)、脉搏血氧饱和度(SpO2)、呼吸频率；观察术中并发症的发生情况.结果 与麻醉诱导时比较,手术开始、手术开始后20 min、手术结束时的心率、RR明显降低,差异有统计学意义(P＜0.05)；各时间点MAP、SpO2差异无统计学意义(P＞0.05).诱导达到外科手术条件时间9 ～ 12 min,瑞芬太尼最大输注速度为(0.18 ±0.03) μg·kg-1·min-1.3例(11％)患儿出现肢体运动,单次缓慢给予丙泊酚1 mg/kg后消失；2例(7％)患儿术中短暂出现SpO2＜ 95％,予降低瑞芬太尼输注速度后缓解.术中无咳嗽、低氧血症、喉痉挛、恶心、呕吐、心率失常并发症发生.结论 先天性喉软化症患儿麻醉管理的关键是术前仔细评估患儿合并的其他疾病,使用保留自主呼吸的全凭静脉麻醉技术,加强术中监测,合理调整麻醉深度.
目的 探討先天性喉軟化癥手術的痳醉管理.方法 迴顧性分析浙江大學醫學院附屬兒童醫院2010年12月至2012年11月擬診斷為先天性喉軟化癥患兒27例,經鼻插入相應大小的氣管導管至聲門上方給氧,連續靜脈輸註丙泊酚和瑞芬太尼維持痳醉,保留患兒自主呼吸.記錄痳醉時間、手術時間、瑞芬太尼最大輸註速度；術中鑑測心電圖、心率、平均動脈壓(MAP)、脈搏血氧飽和度(SpO2)、呼吸頻率；觀察術中併髮癥的髮生情況.結果 與痳醉誘導時比較,手術開始、手術開始後20 min、手術結束時的心率、RR明顯降低,差異有統計學意義(P＜0.05)；各時間點MAP、SpO2差異無統計學意義(P＞0.05).誘導達到外科手術條件時間9 ～ 12 min,瑞芬太尼最大輸註速度為(0.18 ±0.03) μg·kg-1·min-1.3例(11％)患兒齣現肢體運動,單次緩慢給予丙泊酚1 mg/kg後消失；2例(7％)患兒術中短暫齣現SpO2＜ 95％,予降低瑞芬太尼輸註速度後緩解.術中無咳嗽、低氧血癥、喉痙攣、噁心、嘔吐、心率失常併髮癥髮生.結論 先天性喉軟化癥患兒痳醉管理的關鍵是術前仔細評估患兒閤併的其他疾病,使用保留自主呼吸的全憑靜脈痳醉技術,加彊術中鑑測,閤理調整痳醉深度.
목적 탐토선천성후연화증수술적마취관리.방법 회고성분석절강대학의학원부속인동의원2010년12월지2012년11월의진단위선천성후연화증환인27례,경비삽입상응대소적기관도관지성문상방급양,련속정맥수주병박분화서분태니유지마취,보류환인자주호흡.기록마취시간、수술시간、서분태니최대수주속도；술중감측심전도、심솔、평균동맥압(MAP)、맥박혈양포화도(SpO2)、호흡빈솔；관찰술중병발증적발생정황.결과 여마취유도시비교,수술개시、수술개시후20 min、수술결속시적심솔、RR명현강저,차이유통계학의의(P＜0.05)；각시간점MAP、SpO2차이무통계학의의(P＞0.05).유도체도외과수술조건시간9 ～ 12 min,서분태니최대수주속도위(0.18 ±0.03) μg·kg-1·min-1.3례(11％)환인출현지체운동,단차완만급여병박분1 mg/kg후소실；2례(7％)환인술중단잠출현SpO2＜ 95％,여강저서분태니수주속도후완해.술중무해수、저양혈증、후경련、악심、구토、심솔실상병발증발생.결론 선천성후연화증환인마취관리적관건시술전자세평고환인합병적기타질병,사용보류자주호흡적전빙정맥마취기술,가강술중감측,합리조정마취심도.
Objective To explore our experience of anesthetic management for pediatric congenital laryngomalacia operation.Methods A total of 27 pediatric patients with congenital laryngomalacia were treated at our hospital between December 2010 and November 2012.All patients were anesthetized by intravenous anesthesia of propofol-remifentanil and spontaneous breathing.Oxygen was insufflated at a rate of 4 L/min through an endotracheal tube near glottis.Propofol was set at a constant rate of 100 μg · kg-1 min 1 The initial dose of remifentanil at 0.05 μg · kg-1 · min-1 was adjusted in 0.05 μg · kg-1 · min-1 increments to titrate a 50％ reduction in baseline respiratory rate.Heart rate (HR),mean arterial pressure,pulse oxygen saturation (SpO2),respiratory rate (RR),operation time,anesthesia time and remifentanil rate were recorded.Adverse events and interventions were also examined.Results Comparison with induction of anesthesia,HR and RR changed significantly intraoperatively (P ＜ 0.05).MAP,SpO2 were no significantly change during operation (P ＞ 0.05).The induction time was 9-12 min and the highest remifentanil rate stood at(0.18 ±0.03) μg · kg-1 · min-1.Body movements occurred in 3 (11％) patients and a bolus of propofol was administered.Desaturation below 95％ occurred in 2 (7％) patients in which interventions were offered by decreasing the remifentanil infusion rate.No complications such as cough,hypoxemia,laryngospasm or bronchospasm,nausea or vomiting,arrhythmia were observed.Conclusion Key points of anesthetic management for pediatric congenital laryngcmalacia include sufficient preoperative evaluation,spontaneous respiration anesthesia technique with total intravenous anesthesia,suitable anesthesia depth and intensive intraoperative monitoring.
