硬支气管镜置入条件评分在气管异物取出术中应用的可行性探讨

Discussion on the Feasibility of the Application of the Evaluation Score of Open-tube Bronchoscope in the Removal of Tracheobronchial Foreign Bodies

目的探讨小儿气管异物取出术中硬质支气管镜置入条件评分的可行性。方法就诊于本院的气管异物患儿70例,美国麻醉医师协会体格情况分级(The American Society of Anesthesiologists Physical Status Classification System,ASA体格情况分级)Ⅰ或Ⅱ级,年龄1～3岁,体重9～16 kg,随机分为两组(n=35):Ⅰ组(不评分组)和Ⅱ组(评分组)。麻醉诱导:分别静脉注射异丙酚2 mg/kg,芬太尼2μg/kg,并静脉输注异丙酚10～12 mg.kg-1.h-1。Ⅰ组诱导后9 min,Ⅱ组评分达到5分时置镜,两组术中出现体动或呛咳时均追加异丙酚1～2 mg/kg。记录置镜即刻(T0),置镜后5 min(T1)、10 min(T2),退镜即刻(T4)的HR、MAP和SpO2;记录诱导时间,手术时间,苏醒时间和异丙酚的用量;以及术中和苏醒期不良反应的发生情况。结果术中两组间各时点HR、MAP和SpO2比较,差异无统计学意义(P>0.05);与基础值比较,T1和T2的HR增加,MAP升高,差异有统计学意义(P<0.05);两组手术时间、苏醒时间的比较,差异无统计学意义(P>0.05),与Ⅰ组比较,Ⅱ组诱导时间延长,异丙酚用量增加,差异有统计学意义(P<0.05);诱导期和苏醒期两组不良反应的比较,差异无统计学意义(P>0.05);与Ⅰ组比较,Ⅱ组术中去氧饱和(SpO2<90%超过5s定义为发生1次去氧饱和)、呛咳和体动的发生均减少,差异有统计学意义。结论硬支气管镜置入条件评分可在小儿气管异物取出术中应用。

Objective To discuss the feasibility of the application of the evaluation score of open-tube bronchoscope in the removal of tracheobronchial foreign bodies.Methods 70 cases,grade I or grade II according to ASA,aged from 1 year to 3 years old with weight of 9kg to 16kg,were randomly divided into 2 groups： Group I（non-score） and Group II（score）,35 in each;anesthesia induction was made by intravenous injection of propofol 2mg/kg,fentanyl and intravenous infusion of propofol 10～12mg·kg^-1·h^-1;the scope implantation was performed just after anesthesia induction in Group I and that in Group II was made when the score reached 5,and propofol 1～2mg/kg was added when the patients in both groups moved their bodies or coughed;HR,MAP and SpO2 was recorded at the timepoint of implantation,5 minutes（T1）,10 minutes（T2）after the implantation and at the timepoint of the scope withdraw;the time of induction,operation and analepsia were recorded as well as the dosage of propofol;the side effect in operation and analepsia was observed.Results The comparison of HR,MAP and SpO2 between the 2 groups was of no statistical difference（P〉0.05）;comparing with the basic data,HR at T1 and T2 increased and MAP rose up,the difference was of statistical difference（P〉0.05）;the comparison of operation time and analepia between the 2 groups had no statistical difference（P〉0.05）;the time for induction in Group II was longer than that in Group I,and the dosage of propofol inGroup II was bigger than that in Group I,the difference was of statistical significance（P〉0.05）;there existed no differenceof side effect in induction and analepsia between the 2 groups（P〉0.05）;the occurrence of desaturator（SpO2〈90% for over 5 seconds meant desaturator once）,body move and cough in Group II was lower than that in Group I,the difference was of statistical significance.Conclusions The evaluation score of open-tube rigid bronchoscope can be applied in the removal of tracheobronchial foreign bodies.