三种静脉麻醉法用于小儿气管异物取出术的效果比较

A comparative study of three anesthetic methods for tracheobronchial foreign body removal in children

目的观察小儿气管异物取出术常用麻醉方法的临床效果,并探讨肌肉松弛药和控制呼吸用于小儿气管异物取出术的可行性。方法回顾小儿气管异物取出术110例,采用三种麻醉法。A组33例,肌肉注射硫喷妥钠10 mg/kg或氯胺酮5 mg/kg,入睡后静脉注射γ-羟基丁酸钠(γ-OH)100 mg/kg;B组42例,静脉注射芬太尼2μg/kg、丙泊酚2 mg/kg、γ-OH80 mg/kg;C组35例,静脉注射芬太尼3μg/kg、丙泊酚2 mg/kg、阿曲库铵0.25 mg/kg。A、B组保留自主呼吸并辅助高频喷射通气,C组采用高频喷射通气或麻醉机控制呼吸。结果110例全部成功取出异物。术中呛咳和(或)屏气例数、术中SpO2<90%的例数C组显著低于A、B组,手术医师满意度C组显著高于A、B组(P<0.01)。而A、B之间上述数据均无显著差异(P>0.05)。麻醉恢复时间C组明显短于A、B组(P<0.01),B组又短于A组(P<0.05)。结论三种麻醉方法均适用于小儿气管异物取出术,但C组由于选择了短效麻醉药物、中短效肌肉松弛剂和控制呼吸,麻醉更平稳,生理干扰小,术后苏醒快。

Objective To observe the clinical effect of three conventional anesthetic methods for traeheobronchial foreign body removal in children, and to explore the feasibility of muscle relaxants and controlled ventilation in the removal of the foreign bodies in children. Methods 110 children who underwent traeheo -bronchial foreign body removal with bronehoseopy were reviewed retrospectively. Three anesthetic methods were applied in the patients respectively. 33 patients received method A, in which thiopental sodium （10 mg/kg） or ketamine （5mg/kg） was administered intramuscularly, followed by intravenous γ-OH （100 mg/kg） after sleep onset. 42 patients received method B, in which fentanyl （2 μg/kg）, propofol （2 mg/kg） and γ- OH （80 mg/kg） were administered intravenously. 35 patients were given method C, in which fentanyl （3 μg/kg） , propofol （2 mg/kg） and atracurium （0.25 mg/kg） were administered intravenously. Patients in method A and B, were managed by spontaneous ventilation with assisted high - frequency jet ventilation, while patients in method C received controlled ventilation with high - frequency jet ventilation or anesthesia machine. Results Foreign bodies were successfully extracted in 110 patients. The incidences of bucking and/or breath - holding, and the number of SpO2 〈 90% in method C were significantly lower than those in method A or B （P 〈0.01 ） , but the degree of surgeon＇ s satisfaction was higher than method A or B （P 〈0.01 ）. However, between method A and B, they were no significant difference （P 〉0.05）. The awakening time from anesthesia in method C was significantly shorter than method A or B （ P 〈 0. 01 ） , and that in method B shorter than method A （P 〈 0.05）. Conclusions The three anesthetic methods are all applicable to tracheo -bronchial foreign body removal with bronchoscopy in children. Method C has more stable anesthesia, shorter awakening time and fewer complications.