呼吸道复发性乳头状瘤患儿术中缺氧耐受的观察

The hypoxia tolerance of children with recurrent respiratory papillomatosis in surgical procedures

目的：探讨采用气管内镜及微切割钻治疗气管内乳头状瘤患儿在全身麻醉过程中间断拔出气管插管进行手术操作时,患儿对通气暂停的耐受情况。方法：选取40例有气管内累及的呼吸道乳头状瘤患儿,在全身麻醉手术过程中间断拔出气管插管进行手术操作,观察脉搏血氧饱和度（SpO2）由100%下降到99%,95%,90%,85%时所用的时间及当时的心率、SpO2降至85%时的血氧分压（PaO2）、二氧化碳分压（PaCO2）、pH。SpO2重新回升至100%时所用的时间以及PaO2、PaCO2、pH。结果：拔出气管插管后SpO2由100%下降到99%,95%,90%,85%时的平均时间（s）依次为168.4±58.3,204.6±56.4,224.8±58.9,239.9±60.6;平均心率（次/min）依次为121.6±14.6、123.3±15.1、124.1±14.8、125.0±15.1;SpO2为85%时的PaO2为（52±7.9）mmHg,PaCO2为（69±8.7）mmHg,pH为7.22±0.05;SpO2回升至100%所需时间为（28.6±2.5）s,PaO2为（358±104.3）mm-Hg,PaCO2为（40.5±2.0）mmHg,pH为7.40±0.02。结论：呼吸道乳头状瘤患儿在手术时通过间歇通气给氧是安全可靠的,单次通气暂停时间控制在3~5 min时,患儿出现的低氧和高碳酸血症可被及时纠正。

Objective：To investigate hypoxia tolerance of children with recurrent respiratory papillomatosis with the spread of trachea in surgical procedures without ventilation via endotracheal tube intermittently under general anesthesia.Method：Forty children with recurrent respiratory papillomatosis were enrolled in the observation.The duration of SpO2 from 100% to the points of 99%,95%,90%,85%,the heart rate in each time point above.PaO2,PaCO2,pH valve when SpO2 was 85%,the duration of SpO2 back to 100% were recorded respectively.Result：Duration of SpO2 from 100% down to 99%,95%,90%,85% was（168.4±58.3）s,（204.6±56.4） s,（224.8±58.9）s,（239.9±60.6）s,respectively.Heart rate was（121.6±14.6）bpm,（123.3±15.1）bpm,（124.1±14.8）bpm,（125.0±15.1）bpm,respectively.When SpO2 was 85%,pH value was 7.22±0.05,PCO2 was（69±8.7）mmHg,PO2 was（52±7.9）mmHg.Duration of SpO2 up to 100% was（28.6±2.5）s;When SpO2 back to 100%,pH value was 7.40±0.02,PCO2 was（40.5±2.0）mmHg,PO2 was（358±104.3）mmHg.Conclusion：Intermittent apnea during the surgical procedures in RRP children with distal spread of papillomas was safe,hypercapnia and hypoxia caused by the apnea can be corrected soon after the re-ventilation.Duration of apnea should be controlled within 3-5 minutes in each apnea-reoxygenation cycle.