小儿支气管异物取出手术麻醉方式的选择

Selection of anesthesia ways for bronchial foreign body removal in children

目的:探讨小儿支气管异物取出手术安全可靠的麻醉方式。方法:回顾性分析481例小儿支气管异物患儿分别使用全身麻醉和咽部黏膜表面麻醉进行异物取出术的治疗效果。结果:全身麻醉下行支气管异物取出术296例中1次成功取出异物295例,失败率为0.34%;1%丁卡因咽部黏膜表面麻醉下行支气管异物取出术185例中1次成功取出异物175例,失败率为5.40%,2次成功取出异物8例,术后并发喉头水肿10例,其中使用全身麻醉2例,1%丁卡因咽部黏膜表面麻醉8例;术后并发喉痉挛12例,其中使用全身麻醉1例;行气管切开4例,窒息死亡2例,死亡率为0.42%,皆为使用1%丁卡因咽部黏膜表面麻醉者。结论:全身麻醉下行支气管异物取出术1次成功与失败率明显低于黏膜表面麻醉下行支气管异物取出术,术后并发症少,值得临床推广应用。

Objective：To study the safe and reliable anesthesia ways for bronchial foreign body removal in children.Methods：To retrospectively analyze the therapeutic efficacies in 481 children cases of bronchial foreign body removal by intravenous general anesthesia or pharyngeal mucosal surface anesthesia.Results：In 296 children cases of bronchial foreign body removal under general anesthesia,the foreign bodies were successfully removed out in 295 cases by only once operation with the failure rate of 0.34%.In 185 cases of using 1% tetracaine surface anesthesia of the pharyngeal mucosa,there were 175 cases of successful foreign body removal by only once operation and 8 cases by twice operation,with failure rate of 5.40%.In 10 cases of postoperative laryngeal edema,2 cases were under general anesthesia and 8 cases received pharyngeal mucosal surface anesthesia.In 12 cases of postoperative laryngospasm,only 1 case was used general anesthesia.4 cases were performed tracheotomy.2 cases of using pharyngeal mucosal surface anesthesia died of suffocation with the mortality rate of 0.42%.Conclusion：The bronchial foreign body removal in children by intravenous general anesthesia has the obviously lower failure rate than by using 1% tetracaine surface anesthesia of the pharyngeal mucosa with less postoperative complications,which is worth to application and dissemination in clinic.