小婴儿电视胸腔镜手术的麻醉管理

Anesthetic management of video-assisted thoracoscopic surgery in infants

目的探讨小婴儿电视胸腔镜手术(VATS)在单腔气管插管辅以CO2人工气胸麻醉下的可行性和安全性。方法43例10个月￣3岁、体重7.2￣12.0kg的膈疝患儿实行VATS,经快速诱导后插入单腔气管导管,术中辅以CO2人工气胸,连续监测心率(HR)、平均动脉压(MAP)、心电图(ECG)、脉搏血氧饱和度(SpO2)、呼气末CO2分压(PETCO2)、最大吸气压(PIP),分别于气胸前、气胸后10min及30min、放气后10min记录各监测值。结果43例患儿术中麻醉维持平稳,与气胸前相比,血氧饱和度、血压、心率术中变化差异无显著性,气胸后10minPIP显著升高,气胸后30minPETCO2显著升高,放气后10minPIP、PETCO2与气胸前差异无显著性。结论单腔气管插管辅以CO2人工气胸用于小婴儿VATS具有操作简单、麻醉管理方便、安全可靠等优点。

[Objective] To investigate the availability and safety of single-lumen bronchial intubation and CO2, pneumothorax in infants with Video-assisted thoraeoscopie surgery （VATS）. [Methods] 40 infant patients with diaphragmatic hernia were elective operated under single-lumen bronchial intubation and CO2. pneumothorax ECG, HR, MAP, SpO2, PETCO2, PIP were continuously monitored. [Results] All 43 infants obtained a steady maintenance of anesthesia. Compared with the data before operation, the changes of HR, MAP, SpO2 were not significant during the operation, PIP increased significantly （P 〈0.05） at 10 minutes after CO2, pneumothorax. PETCO2 increased significantly （P 〈0.05） at 30 minutes after CO2 pneumothorax. [Conclusions] The usage of single-lumen bronchial intubation and CO2, pneumothorax in infants with VATS have advantages of safety, reliability, simple operation and easy management.