中华麻醉学杂志
中華痳醉學雜誌
중화마취학잡지
CHINESE JOURNAL OF ANESTHESIOLOGY
2013年
7期
880-882
,共3页
朱智瑞%胡智勇%蒋一蕾%金海燕
硃智瑞%鬍智勇%蔣一蕾%金海燕
주지서%호지용%장일뢰%금해연
插管法,气管内%麻醉,吸入%呼吸%喉肿瘤%乳头状瘤%儿童
插管法,氣管內%痳醉,吸入%呼吸%喉腫瘤%乳頭狀瘤%兒童
삽관법,기관내%마취,흡입%호흡%후종류%유두상류%인동
Intubation,intratracheal%Anesthesia,inhalation%Respiration%Laryngeal neoplasms%Papilloma%Child
目的 评价双腔深静脉导管用于小儿自主呼吸下喉乳头状瘤切除术气道管理的效果.方法 择期行支撑喉镜下喉乳头状瘤切除术患儿29例,性别不限,年龄1～9岁,体重10 ～ 35 kg,ASA分级Ⅰ或Ⅱ级.吸入8％七氟醚行麻醉诱导,保留自主呼吸,采用2％利多卡因喷喉行表面麻醉,置入支撑喉镜,经支撑喉镜置入7F双腔深静脉导管至声门下,经端孔吹入4％ ～6％七氟醚维持麻醉,经侧孔检测PETCO2.于术前(T1)、手术20 min时(T2)和术毕(T3)采集动脉血样,行血气分析；记录术中体动、低氧血症(吸氧时SpO2＜95％)、气道管理失败(吸氧时SpO2＜ 90％)的发生情况.结果 与T1比较,T2,3时PaCO2、BE、pH值、PaO2的差异虽然有统计学意义(P＜0.05),但均在临床允许范围内；T1-3时PaCO2与PETCO2比较差异无统计学意义(P＞0.05)；术中体动、低氧血症的发生率均为10％,气道管理失败率3％(因Ⅲ度喉梗阻).结论 双腔深静脉导管可安全、有效地用于Ⅰ或Ⅱ度喉阻塞小儿七氟醚吸入麻醉-自主呼吸下喉乳头状瘤切除术的气道管理.
目的 評價雙腔深靜脈導管用于小兒自主呼吸下喉乳頭狀瘤切除術氣道管理的效果.方法 擇期行支撐喉鏡下喉乳頭狀瘤切除術患兒29例,性彆不限,年齡1～9歲,體重10 ～ 35 kg,ASA分級Ⅰ或Ⅱ級.吸入8％七氟醚行痳醉誘導,保留自主呼吸,採用2％利多卡因噴喉行錶麵痳醉,置入支撐喉鏡,經支撐喉鏡置入7F雙腔深靜脈導管至聲門下,經耑孔吹入4％ ～6％七氟醚維持痳醉,經側孔檢測PETCO2.于術前(T1)、手術20 min時(T2)和術畢(T3)採集動脈血樣,行血氣分析；記錄術中體動、低氧血癥(吸氧時SpO2＜95％)、氣道管理失敗(吸氧時SpO2＜ 90％)的髮生情況.結果 與T1比較,T2,3時PaCO2、BE、pH值、PaO2的差異雖然有統計學意義(P＜0.05),但均在臨床允許範圍內；T1-3時PaCO2與PETCO2比較差異無統計學意義(P＞0.05)；術中體動、低氧血癥的髮生率均為10％,氣道管理失敗率3％(因Ⅲ度喉梗阻).結論 雙腔深靜脈導管可安全、有效地用于Ⅰ或Ⅱ度喉阻塞小兒七氟醚吸入痳醉-自主呼吸下喉乳頭狀瘤切除術的氣道管理.
목적 평개쌍강심정맥도관용우소인자주호흡하후유두상류절제술기도관리적효과.방법 택기행지탱후경하후유두상류절제술환인29례,성별불한,년령1～9세,체중10 ～ 35 kg,ASA분급Ⅰ혹Ⅱ급.흡입8％칠불미행마취유도,보류자주호흡,채용2％리다잡인분후행표면마취,치입지탱후경,경지탱후경치입7F쌍강심정맥도관지성문하,경단공취입4％ ～6％칠불미유지마취,경측공검측PETCO2.우술전(T1)、수술20 min시(T2)화술필(T3)채집동맥혈양,행혈기분석；기록술중체동、저양혈증(흡양시SpO2＜95％)、기도관리실패(흡양시SpO2＜ 90％)적발생정황.결과 여T1비교,T2,3시PaCO2、BE、pH치、PaO2적차이수연유통계학의의(P＜0.05),단균재림상윤허범위내；T1-3시PaCO2여PETCO2비교차이무통계학의의(P＞0.05)；술중체동、저양혈증적발생솔균위10％,기도관리실패솔3％(인Ⅲ도후경조).결론 쌍강심정맥도관가안전、유효지용우Ⅰ혹Ⅱ도후조새소인칠불미흡입마취-자주호흡하후유두상류절제술적기도관리.
Objective To evaluate the efficacy of double-lumen central venous catheter (DLCVC) for airway management in children undergoing resection of laryngeal papilloma under inhalation anesthesia with sevoflurane-spontaneous breathing.Methods Twenty-nine ASA physical status Ⅰ or Ⅱ podiatric patients,aged 1-9 yr,weighing 10-35 kg,scheduled for elective resection of laryngeal papilloma under self-retaining laryngoscope,were included in this study.Anesthesia was induced with inhalation of 8 ％ sevoflurane and the children kept spontaneous breathing.The larynx was sprayed with 2％ lidocaine for topical anesthesia.A self-retaining laryngoscope was inserted and a 7F DLCVC was placed below the glottis via the self-retaining laryngoscope.4％-6％ sevoflurance was insufflated via the main lumen of DLCVC (14G) to maintain anesthesia.PETCO2 was monitored through the branch lumen of DLCVC (18G).Before surgery (T1),at 20 min after the beginning of surgery (T2),and at the end of surgery (T3),arterial blood samples was obtained for blood gas analysis,and body movement,hypoxemia (SpO2 ＜ 95 ％ during oxygen inhalation),and airway management failure (SpO2 ＜ 90％ during oxygen inhalation) were also recorded.Results Compared with the baseline value at T1,although there were significant changes in PaCO2,base excess,pH value and PaO2 at T2 and T3 (P ＜ 0.05),they were all within the clinical reference ranges.There were no significant differences between PaCO2 and PETCO2 at T1,T2 and T3 (P ＞ 0.05).The incidence of body movement and hypoxemia was 10％,and the rate of airway management failure was 3％ (due to degree Ⅲ laryngeal obstruction).Conclusion DLCVC can be safely and effectively used for airway management in children with degree Ⅰ or Ⅱ laryngeal obstruction undergoing resection of laryngeal papilloma under inhalation anesthesia with sevoflurane-spontaneous breathing.
