小儿麻醉中的呕吐反流误吸49例临床分析

Aspiration of gastric contents in pediatric anaesthesia:analysis of 49 cases

目的 探讨小儿麻醉中呕吐反流误吸的发生原因及防治措施。方法 对小儿麻醉中发生了呕吐反流误吸的49 例病例进行临床分析。结果 49 例呕吐反流误吸发生在麻醉诱导时有 16 例(32. 7%);术中探查操作或渗血液吸引刺激时 21 例(42.9%);术中外科操作错误2例(4.1%);术毕气管导管拔管时10例(20.4%)。即刻发现呕吐反流误吸48 例,因吸引器故障吸引欠及时2例,1例因麻醉师离开手术间而未及时发现呕吐反流误吸。进行头侧位吸引 49 例;气管插管灌洗吸痰 29 例;发生呼吸心跳停止2例,发生呼吸抑制心跳减慢8例,进行心肺复苏10例。无肺部并发症33例;有肺部并发症15例;死亡 1 例,系未及时发现呕吐反流误吸,经心肺复苏初期成功,但术毕死于呼吸窘迫综合症。结论 禁食时间不够或隐瞒进食史,麻醉方式选择欠妥当,操作手法不当以及麻醉不完善等是引起小儿麻醉中呕吐反流误吸的常见原因;而充分的术前准备,恰当的麻醉选择,正确的操作,严密的术中监测以及高度的责任心是切实有效的防范措施。

Objective To explore the cause and prevention measure of aspiration of gastric contents during anaesthesia in infants.Methods Retrospective analysis was used to study on forty-nine cases who suffered aspiration of gastric contents during anaesthesia.Results The aspiration of 16 (32.7%),21(42.9%),2(4.1%) and 10(20.4%)cases happened in anesthesia induction, surgical exploration, surgical mis-orperation and extubation of tracheal tube respectively. Aspirations of 48 cases were detected immediately except one case due to the temporary departure of anesthetist. All cases were aspirated in the position of lateral head. Twenty-nine cases were douched and sucked with tracheal cannula. Arrest of anapnea or heartbeat happened in 2 cases. Respiratory depression and decreased heartbeat happened in 8 cases.Cardio-pulmonary resuscitation was proceed for 10 patients.Thirty-three cases developed pulmonary complication and 15 cases were free for any complication.One case who wasn not detected aspiration in time, died of respiratory distress syndrome after operation although successful resuscitation in the initial stage was administered.Conclusion Un-sufficient fasting time or hiding the truth of eating, improper chose of anesthesia method, improper operation and un -perfect anaesthesia are common causes leading aspiration of gastric contents in infants. Therefore, sufficient preoperative preparation, appropriate chose of anaesthesia, proper operation,tightly monitoring and good responsibility are effective prevention measure for aspiration of gastric contents.