支撑喉镜下间断通气在小儿复发性喉乳头瘤患者的应用

The evaluation of Apneic anesthesia with intermittent ventilation for juvenile-onset recurrent laryngeal papillomatosis

目的评估支撑喉镜下间断通气在小儿复发性喉乳头瘤中的可行性和安全性。方法2011年10—12月北京同仁医院麻醉科30例复发性喉乳头瘤患儿，美国麻醉医师协会（ASA）Ⅰ～Ⅱ级。行全凭静脉麻醉，根据手术要求拔出气管导管，以脉搏血氧饱和度为指导，95％重新插入气管导管，记录拔管后SpO2降至95％，最低值以及恢复100％所用时间，研究SpO2变化规律，记录再通气后呼气末二氧化碳分压以及变化规律，记录心血管参数变化。SpO2由100％降至95％之间的时间为单次间断通气所能提供的手术时间。结果手术时间为（232±32）s，试验过程血压没有变化，心率明显上升。T2、T3、T4与T1点比较，差异有统计学意义（P〈0．05）。术中没有出现呼吸系统并发症，没有出现苏醒延迟。结论间断通气能够安全用于小儿喉乳头瘤病人的麻醉，每次间断通气可以提供232s的手术时间。

Objective To evaluate the feasibility of Apneic anesthesia with intermittent ventilation （AAIV） during laryngeal papillomatosis removal in children. Methods The clinical data of 30 patients with laryngeal papillomatosis treated in the Tong Ren Hospital of Capital University of Medical Sciences, between 10 - 12 2011 were analyzed. Thirty ASA physical status I or II patients who were scheduled for elective surgery. The patients were ventilated with 100% oxygen and the period of intermittent apnea were guided by pulse oximetry, the endotracheal tube was removed when SpO2 was 100% and reinserted when SpO2 was 95%. Result The average duration of apnea was （232 ± 32） s. This technique provided a good visualization and immobile field for operation. No significant complications have occurred with AAIV. Conclusion Apneic anesthesia with intermittent ventilation could be used without any serious adverse outcome for juvenile-onset recurrent laryngeal papillomatosis ,232 seconds can provided for surgery every AAIV.