麻醉中间歇通气法用于小儿支撑喉镜下喉乳头状瘤切除手术的效果及护理

Effect and nursing of the children under self-retaining laryngoscope papilloma surgery with intermittent ventilation and apneic anaesthesia

目的观察麻醉中间歇通气呼吸暂停法用于小儿支撑喉镜下喉乳头状瘤切除术的效果，并探讨相应的护理方法。方法择期行内镜辅助支撑喉镜下小儿喉乳头状瘤切除术的患儿20例，麻醉方式为气管内全麻，当SpO2达100％和PERCO2低于30mm／Hg时拔出气管导管立即手术，当SpO2达97％时重新插入气管导管及过度通气，如此反复午术毕。术中检测动脉血气，监测MAP、HR、SpO2和PERCO2，记录术者对于术条件的订估情况、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。结果所有患儿均顺利完成手术，苏酬时间为（7±3）min。在手术过程中，PCO2及PaO2虽有波动，但均在临床允许范同内；各观察时间点MAP、HR、Sp02、ptt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个月复发牢为15％。结论红丁术医师、麻醉陕师和护士密切协作下，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中，护理上需侧重呼吸及气道护理。

Objective To investigate the effect and nursing methods of children under the self-retaining laryngoscope papilloma surgery with intermittent ventilation and apncic anaesthesia. Methods Twenty children were selected as study subjects, who were undergoing selective self-retaining laryngoscope papilloma surgery assist with endoscope and with cndotracheal intubation general anaesthesia. When the pulse oxygen saturation achieve 100% and the end expiration carbon dioxide concentration lower than 30mmHg, the intubation was pulled out and a surgery was carried out at once; When the SpO2 was 97% , endotraeheal intubation was made again and hyperventilation. The treatment was repeated till the operation completed. The arterial blood gas, mean arterial pressure, heart rate, saturation of blood oxygen and the end expiration carbon dioxide concentration were monitored. The operation condition assessment by the surgeon, the time that patients come from consciousness; operation complications and the rate of papilloma recurrence three months after operation also were recorded. Results All operations were successfully completed and the time of consciousness was （7 ± 3）min. PCO2 and PaO2 were a little fluetuatitm but in the permissitnl extent. MAP,HR,SpO2 ,pH and PaGO2 were maintained stable （ P 〉 O. 05 ） ; The operation condition assessment has reached ninety percent. No complications have happened. The rate of papilloma recurrence thrce months alter operation was 15%. Conclusions Under the cooperation of the surgeon, anesthetists and nurses, the intermittent ventilation and apneie anaesthesia can be safely used in the children self-retaining laryngoscope papilloma surgery, and the breath and airway attendance should be emphasizes.