1225例次小儿复发性喉乳头状瘤激光手术麻醉的临床分析

Clinical analysis on anesthesia for laser surgery of juvenile recurrent respiratory papillomatosis in 1 225 cases

目的总结分析该院20余年来儿童喉乳头状瘤病例围术期气道管理,以指导临床实践,提高患儿围术期的安全性。方法回顾性总结在本院接受手术治疗的患儿289例,共接受1 225次手术。根据肿瘤的位置和气道阻塞的程度分级。结果根据气道梗阻程度和部位不同,选择不同的麻醉诱导方法。术中使用肌松剂,采用静吸复合或全静脉麻醉。对于声门下乳头状瘤,术中间断呼吸暂停辅以喷射通气。结论对于大多数患儿,经验丰富的麻醉医师可采用快速诱导气管内插管。术中处理声门下肿瘤时,间断辅以呼吸暂停和喷射通气。麻醉、手术医师和护士的合作非常重要。

Objective To summarize the experiences of perioperative airmay management for juvenile recurrant respiratory papillomatasis in the past 20 years in order to guide the clinical practice and improve the safety during the perieperative period. Methods A retrospective analysis of all children underwent the surgery by laser between the year 2003 and 2009 were undertaken. There were 289 patients who received 1 225 times surgery under general anesthesia. Results According to the degree and location of air- way obstruction,different methods were selected for them during anesthetic induction. During the surgery, muscle relax was required for control ventilation. Inhalation and intravenous anesthesia cluld be combined for maintenance. For the tumor under glottis, the trachea needed to he withdrawn during the surgery discontinuously and the surgeon dealed with them rapidly. Conclusion The anesthesia of JO-RRP is very dangerous. The principle is to set up effective airway. Most of the patients can be intubated by experienced anesthesiologists with rapid anesthetic induction and muscle ralaxation. Discontinuous jet ventilation is more appropriate for handling the tumor located under the glottis. The harmonious cooperation with surgeons and nurses is important.