支撑喉镜下喉乳头状瘤切除术小儿间歇通气呼吸暂停麻醉法的效果

Apneic anesthesia with intermittent ventilation under laryngoscopy for pediatric laryngeal papilloma resection

目的评价间歇通气呼吸暂停麻醉法用于小儿支撑喉镜下喉乳头状瘤切除术的效果。方法择期内窥镜辅助支撑喉镜下喉乳头状瘤切除术小儿20例,麻醉诱导后经口插入气管导管,静脉输注异丙酚、瑞芬太尼,间断静脉注射维库溴铵0.08 mg/kg维持麻醉,静脉注射地塞米松0.2 mg/kg防止喉头水肿。手术开始前对小儿行过度通气,PETCO2低于30 mm Hg时拔出气管导管,暂停呼吸,术者尽快手术操作,当SpO2下降到97%时,由术者插入气管导管,立即行过度通气,尽快使SpO2升至100%,当PETCO2低于30 mm Hg时拔出气管导管立即手术,如此反复至术毕。术中检测动脉血气,监测MAP、HR、SpO2和PETCO2,记录术者对手术条件的评估情况、苏醒时间及术后有关并发症及术后3个月内随访肿瘤复发情况。结果所有小儿在麻醉诱导后均一次性成功置入支撑喉镜,苏醒时间为（7±3）min。在整个试验过程中,PETCO2及PaO2虽有一定程度波动,但均在临床允许范围内;MAP、HR、SpO2、pH和PaCO2维持稳定（P〉0.05）。术者评估手术条件的优良率为90%,未见有关并发症发生。术后3个月复发率为15%。结论间歇通气呼吸暂停麻醉法可安全、有效地应用于小儿支撑喉镜下喉乳头状瘤切除术。

Objective To observe the efficiency of apneic anesthesia with intermittent ventilation（AAIV） under laryngoscopy for pediatric laryngeal papilloma removal.Methods Twenty pediatric patients scheduled for laryngeal papillomatosis resection were selected.Anesthesia was induced with intravenous fentanyl and inhalation of sevofluance.Tracheal intubation was facilitated with vecuronium.Anesthesia was maintained with intravenous infusion of propefol and remifentanll and intermittent iv boluses of vecuronium.Dexamethasone was given intravenously to prevent laryngeal edema.The lungs were hyperventilated with 100% oxygen till the PETCO2 decreased to 30 mm Hg,and the endotracbeal tube was removed during the apneie period to provide the surgeon sufficient room in which to operate.The patient was reintubated and hyperventilated again when the SpO2 droped below 97% .The endotracbeal tube was removed again following the SpO2 100% and PETCO2 30 mm Hg to restart microsurgery.The procedures above were performed repeatedly till the end of resection.The following parameters were recorded：the arterial blood gases（pH,PaO2,PaCO2）during perioperatiun;MAP,HR,SpO2 and PETCO2 during operation;the surgeon assessment of operating conditions;time of eye opening on demand;relevant postoperative complications;the recurrence of laryngeal papilloma.Results The time of eye opening on demand was（7±3）min.PETCO2 and PaO2 changed significantly during operation（P〈0.05）,but in the clinical normal range.MAP,HR,SpO2,pH and PaCO2 were unchanged significantly（P〉0.05）.The rate of good operating conditions assessment by surgeon was 90% .No significant complications occurred in PACU.The recurrence rate of laryngeal papilloma was 15% 3 months after operation.Conclusion The apneic anesthesia with intermittent ventilation can be applied safely and efficiently to removal of pediatric laryngeal papillomas under laryngoscopy.