高频喷射通气在小儿气管、支气管异物取出术中的应用

Application of high frequent controlled ventilation for bronchial foreign body removal in children

目的比较气管、支气管异物取出术中保留自主呼吸和高频喷射通气的麻醉安全性。方法120例手术随机分为自主呼吸组(S组,60例)和高频喷射通气组(C组,60例)。S组静脉注入氯胺酮及0.5%丁卡因表面麻醉,手术过程患儿保持自主呼吸。C组用静脉麻醉药同S组,另静脉加用维库溴铵,手术过程患儿无自主呼吸。记录手术时间、插入支气管镜次数、最低血氧饱和度、屏气发生次数和严重并发症心跳骤停或死亡的发生率。结果外科医师在C组中更容易置入支气管镜,达到100%的首次置入率。手术时间:C组(8.46±7.84)min显著低于S组(25.25±11.76)min;插入支气管镜次数:C组(1.30±0.62)次显著低于S组(3.20±0.66)次;最低血氧饱和度:C组(65.26±12.78)%显著高于S组(45.20±14.35)%;屏气发生次数:C组(0.5±0.42)次显著低于S组(2.31±0.48)次;死亡率:C组(0例)显著低于S组(2例)。结论在小儿气管、支气管异物取出术中,高频喷射通气可以降低患儿缺氧风险,提高麻醉安全性。

Objective To compare spontaneous ventilation and high frequent controlled ventilation during intravenous anesthesia for bronchial foreign body removal in children. Methods One hundred and twenty patients were randomly allocated to spontaneous ventilation group（group S, 60 cases） or high frequent controlled ventilation group（group C, 60 cases）. The patients were induced with ketamine, and 0.5 % tetracaine for larynx topical anesthesia maintained spontaneous respiration during operation in group S. In group C,vecuronie was additionally administered besides ketamine and 0.5 % tetracaine for larynx topical anesthesia and controlled ventilation was needed. The records during operation included the operating time, frequency of bronchoscope installation, lowest SpO2 ,times of breath holding,and frequency of severe complications including cardiac arrest and death. Results In group C, surgeon installed bronchoscope more easily than in group S,while the first time success rate reached 100%. The surgery time in group C[（8.46± 7.84）min] was significantly shorter than that in group S[（25.25 ± 11.76）min]. The frequency of b ronchoscope installation in group C（1.30±0.62 ）was significant lower than that in group S（3.20±0.66）. The lowest SpO2 in group C[（65.26±12. 78）%] was significant higher than that in group S[（45.20±14.35） %]. The times of breath holding in group C（0.5±0.42 ）was significant higher than that in group S（2.31 ±0.48）. The frequency of cardiac arrest in group C was lower than in group S（2 vs 5）. The frequency of death in group C was significant lower than in group S（0 vs 2）. Conclusion Using relaxant,controlled high frequent ventilation could provide better anesthesia effect for bronchial foreign body removal in children and reduce the risk of hypoxia.