瑞芬太尼与丙泊酚及琥珀胆碱复合全身麻醉并高频喷射通气在婴幼儿气管异物取出术中的应用

The application of remifentanil, propofol and succinylcholine anesthesia combined with high-frequency jet ventilation on surgery of removing foreign body in trachea of infants

目的 探讨瑞芬太尼与丙泊酚复合琥珀胆碱全身麻醉并高频喷射通气（HFJV）在婴幼儿气管异物取出术的效果及安全性.方法 30例行气管异物取出术的患儿完全随机分为研究组和对照组,每组15例.研究组静脉注射丙泊酚、瑞芬太尼和琥珀胆碱,插入支气管镜后经侧孔FHJV.对照组静脉注射氯胺酮、γ-羟丁酸钠和丙泊酚复合麻醉,保留自主呼吸,插入支气管镜后经侧孔吸纯氧或必要时HFJV.术中连续监测心电图、心率、呼吸和脉搏血氧饱和度（SpO2）,比较2组患儿术中各生命体征变化及发生呛咳、屏气、呼吸暂停、支气管痉挛的次数,手术时间、苏醒时间苏醒期并发症.结果 2组患儿年龄、性别、体重、术前SpO2差异无统计学意义（P＞0.05）.2组患儿的HR置镜前[研究组和对照组分别为（105±4）次/min和（110±6）次/min]较诱导前[研究组和对照组分别为（142±6）次/min和（140±4）次/min]均有明显下降（P＜0.05）,其余各时点变化差异均无统计学意义（P＞0.05）.研究组发生低氧血症5例、心动过缓1例;对照组发生低氧血症25例、呛咳屏气8例、喉支气管痉挛5例、心动过缓4例.对照组不良反应发生率高于研究组,差异有统计学意义（P＜0.05）.研究组平均手术时间（10.9±4.1）min,苏醒时间（30.5±9.2）min;对照组平均手术时间（19.9±5.0）min,苏醒时间（60.2±15.6）min.2组手术及苏醒时间差异具有统计学意义（P＜0.05）.研究组苏醒期发生恶心呕吐2例、躁动1例;对照组发生恶心呕吐7例,躁动4例,喉、支气管痉挛5例.2组患儿恶心呕吐及喉、支气管痉挛的发生率差异有统计学意义（P＜0.05）.结论 在婴幼儿气管异物取出术中,采用瑞芬太尼、丙泊酚复合琥珀胆碱全身麻醉加用HFJV较传统的氯胺酮复合γ-羟丁酸钠保留自主呼吸麻醉能更好地维持患儿呼吸、循环稳定,缩短手术时间,是一种安全、有效的麻醉方法.

Objective To discuss the effect and safety of surgery of removing foreign body in trachea of infants by using remifentanil, propofol and succinylcholine anesthesia combined with high-frequency jet ventilation （HFJV）. Methods Totally 30 infants receiving surgery of removing foreign body in trachea were divided into two groups randomly： study group （propofol, remifentanil and succinylcholine） and control group. Each group has 15 patients. Patients of study group were given intravenous injection of propofol, remifentanil and succinylcholine and eliminated spontaneous breathing. After inserting bronchoscope, HFJV through the side hole was applied. Patients of control group were given intravenous injection of Ⅳ ketamine, γ-sodium hydroxybutyrate, propofol anesthesia and spontaneous breathing was reserved. After bronchoscope insertion, patients absorbed the pure oxygen through the side hole. They were given HFJV when necessary. During the operation, electrocardiogram （ECG）, heart rate （HR） , respiratory （RR） and pulse oxygen saturation（SpO2） were continuously monitored, and compared various changes of vital sign, the times of patient choking, breath holding, apnea, and bronchospasm, and operation time, recovery time and complications during the recovery period. Results The adverse reaction and complications during the recovery period of study group were significantly lower than those in control group（P 〈0.05）. Moreover, surgery and recovery time were significantly shorter than those in control group（P〈0.05）. Conclusion During the surgery of removing foreign body in trachea of infants, the propofol, remifentanil and succinylcholine anesthesia combined with HFJV is superior to the traditional anesthesia in terms of keeping spontaneous breathing in maintaining stable respiration and circulation and reducing operation time.