气道异物取出术患儿Manujet Ⅲ手控喷射通气的效果

Efficacy of jet ventilation with Manujet Ⅲ for removal of airway foreign body in children

目的评价气道异物取出术患儿Manujet Ⅲ手控喷射通气的效果。方法拟行气道异物取出术患儿120例，年龄10月～12岁，体重8～35kg，ASAⅠ或Ⅱ级，随机分为3组（n=40）：S组保留自主呼吸；P组通过硬支气管镜侧孔行手控间歇正压通气；J组喷气导管经鼻置入气管，采用Manujet Ⅲ装置行手控喷射通气。记录术者置镜满意情况、术中缺氧发生情况、异物移除情况、手术时间、麻醉恢复时间和不良反应的发生情况。结果与S组比较，P组和J组手术时间、麻醉恢复时间缩短，置镜满意率升高，术中缺氧发生率、屏气和躁动发生率降低（P〈0．05）；与P组比较，J组术中缺氧发生率降低（P〈0．05）。结论气道异物取出术患儿术中使用Manujet Ⅲ装置行手控喷射通气可降低术中缺氧的发生机率，且不影响术者操作。

Objective To evaluate the efficacy of manually controlled jet ventilation with Manujet Ⅲ apparatus （VBM Co, Germany） for removal of airway foreign body in children. Methods One hundred and twenty ASA Ⅰ or Ⅱ children aged 10 months-12 yr, weighing 8-35 kg undergoing removal of airway foreign body were randomly divided into 3 groups （ n = 40 each） ： group Ⅰ spontaneous respiration （SR） ; group Ⅱ intermittent positive pressure ventilation through the short side tube of the rigid bronchoscope （IPPV） and group m manually controlled jet ventilation with Manujet Ⅲ （JV）. Anesthesia was induced with methylprednisolone 2 mg/kg, propofol 2 mg/kg and 7-OH 70 mg/kg in group SR （ Ⅰ ） and with methylprednisolone 2 mg/kg, propofol 4- 5 mg/kg, fentanyl 1.5 tLg/kg and succinylcholine 2 mg/kg in group IPPV and JV （ Ⅱ , Ⅲ ）. The bronchoscope insertion condition, the occurrence of hypoxia during and after operation, body movement during operation, the rate of successful removal of the foreign body, the duration of operation, anesthesia emergence time and perioperative side effects were recorded. Results The rate of good bronchoscope insertion condition and successful removal of airway foreign body were significantly higher, the rate of hypoxia during and after operation, body movement, breath holding and restlessness were significantly lower and duration of operation and anesthesia emergence time were significantly shorter in group IPPV and JV than in group SR （ P 〈 0.05）. The rate of intraoperative hypoxia was significantly lower in group JV than in group IPPV （ P 〈 0.05 ）. Conclusion Jet ventilation with Manujet Ⅲ can reduce the occurrence of hypoxia during removal of airway foreign body in children and does not interfere with the operation.