儿童麻醉诱导期间丙泊酚致严重支气管痉挛的临床分析

Clinical Analysis of Propofol-induced Severe Bronchospasm During Anesthesia Induction

目的:探讨儿童麻醉诱导期间丙泊酚导致严重支气管痉挛的好发因素、临床特点、处理及预后。方法:对2005年1月～2009年12月我院小儿麻醉诱导期间3例丙泊酚致严重支气管痉挛进行回顾性分析。结果:支气管痉挛发生率为0.57%。3例小儿麻醉前有上呼吸道感染史,为高气道反应患儿;3例否认药物和食物过敏史,1例哮喘病史;临床表现为重度支气管痉挛及双肺内哮鸣音、紫绀、SpO_2下降至80%～90%,Paw>30cmH_2O,HR明显增快,BP下降,颈胸部皮肤潮红,为丙泊酚类过敏反应;静脉注射多索茶碱+地塞米松+长托宁,气管导管喷入沙丁胺醇气雾剂,肌注异丙嗪疗效较明显。结论:高气道反应小儿全身麻醉丙泊酚诱导时应警惕严重支气管痉挛的发生,应及时诊断和处理。

Objective： To discuss the clinical characteristics, treatments and preventive methods of propofol-induced severe bronchospasm during anesthesia induction. Methods： Clinical data of 3 cases of propofol-induced severe bronchospasm during anesthesia induction were analyzed retrospectively. Results： The occurrence rate of severe bronchospasm was 0.57%. These three patients all had airway hyperresponsiveness with a history of upper respiratory infection. One had a history of asthma and the other two denied the allergic history of drug or food. The clinical manifestations included severe bronchospasm, wheezing rules in lung, cyanosis, increased heart rate and erubescence of neck and chest skin. The patients were underwent intravenous injection of doxofylline, dexamethasone and penehyclidine hydrochloride, albuterol aerosol inhalation from endotracheal catheter, intramuscular injection of promethazine. The therapy was effective for these three cases. Conclusion： Propofol may cause anaphylactoid reaction and severe bronchospasm during anesthesia induction. Histamine releasing drugs as well as inducements of bronchospasm and acute attack of asthma should be avoided in patients with allergic history while using propofol. In addition, the rescue measures should be prepared for allergy emergencies.