气管内乳头状瘤激光切除术患儿间歇通气呼吸暂停麻醉应用时限的探讨

Time limit of apneic anesthesia with intermittent ventilation applied in endotracheal papilloma removal in childhood patients

目的观察气管内乳头状瘤切除术患儿采用间歇通气呼吸暂停麻醉（AAIV）的安全性。方法选取喉及气管内乳头状瘤患儿22例,年龄2~10岁,均采用全静脉麻醉并使用非去极化肌松药,气管内插管机械通气。吸纯氧过度通气后,间断拔出气管导管进行气管内肿瘤切除,记录脉搏血氧饱和度（SpO2）由100%下降到95%、90%、85%所需时间,以及在此3个时间点的SpO2、动脉氧分压（PaO2）、动脉二氧化碳分压（PaCO2）及心率等指标的变化。结果共22例入组,SpO2由100%下降到95%、90%、85%的时间分别为202±502、24±552、40±59s;SpO2为95%、90%、85%时PaO2分别为86±126、2±12、57±11mmHg;PaCO2分别为56±12、70±118、3±16mmHg。患儿均未出现心律失常、麻醉后清醒延迟等缺氧相关并发症。结论 AAIV可安全用于小儿气管内乳头状瘤切除术。在充分氧合,适当过度通气的条件下,单次呼吸暂停时间可控制在180~240s。

Objective To evaluate the safety of apneic anesthesia with intermittent ventilation（AAIV） employed in endotracheal papilloma removal in childhood patients,and explore the gateway of prolonging the apneic duration,so as to facilitate the endotracheal surgical procedure as safe as possible.Methods Twenty-two children,aged 2-10 years,suffering from endotracheal papilloma without severe heart and lung diseases,were enrolled.After over-ventilation with 100% oxygen,ventilation was stopped by pulling out the endotracheal tube.The time intervals of saturated pulse oxygen（SpO2） declining from 100% down to 95%,90% and 85% were recorded.Heart rate（HR）,arterial oxygen pressure（PaO2） and arterial carbon dioxide pressure（PaCO2） were also recorded when SpO2 reached 90%,85% and 80%.Results The time intervals of SpO2 decline from 100% down to 95%,90% and 85% were 202±50s,224±55s and 240±59s,respectively.When SpO2 reached 95%,90% and 85%,the PaO2 was 86±12mmHg,62±12mmHg and 57±11mmHg respectively,while PaCO2 was 56±12mmHg,70±11mmHg and 83±16mmHg respectively.Conclusions Apneic anesthesia with intermittent ventilation can be safely used in the surgery of children with endotracheal papilloma.The time of single apnea may be up to 180-240 seconds under the condition of sufficient oxygenation and proper ventilation.