间歇通气呼吸暂停麻醉法在儿童输尿管软镜钬激光碎石术中的应用

Application of apneic anesthesia with intermittent ventilation in pediatric holmium laser lithoclasty with flexible ureteroscope

目的 评价间歇通气呼吸暂停麻醉法在儿童输尿管软镜钬激光碎石术中的安全性与有效性.方法 选择气管内插管全身麻醉下输尿管软镜钬激光碎石术患儿30例.采用间歇通气呼吸麻醉法,呼吸暂停时间为2 min,呼吸暂停次数为5次,根据手术需要行呼吸暂停.观察记录患儿手术开始前（Ta）、第1次呼吸暂停2 min后（T1）、第2次呼吸暂停2 min后（T2）、第3次呼吸暂停2 min后（T3）、第4次呼吸暂停2 min后（T4）、第5次呼吸暂停2 min后（T5）,手术结束后15 min（Tb）各个时间点的心率、血压、pH、PaCO2、PaO2.结果 患儿Ta、T1～T5各时间点的心率、血压均无明显差异（P〉0.05）;T1 ～T5各时间点pH值较Ta比较有所下降（P〈0.05）,至Tb时间点时pH回升恢复至正常水平;T1～T5各时间点PaCO2值较Ta比较升高（P〈0.05）,至Tb时间点下降恢复至正常水平.Ta、Tb PO2值比较比较无明显差异（P〉0.05）,T1～T5各时间点PaO2值较Ta有所下降（P〈0.05）,但最低值〉380 mmHg.结论 间歇通气呼吸暂停麻醉法可安全、有效地应用于儿童输尿管软镜钬激光碎石术.

Objetive To research the application of apneie anesthesia with intermittent ventilation in pe- diatric holmium laser lithoelasty with flexible ureteroscope. Methods Thirty children undergoing holmium la- ser lithoclasty with flexible ureteroscope were selected for apneie anesthesia with intermittent ventilation. Apnea time was 2 minutes, the apnea interval time was according to the requirement of operation, and the times of ap- nea was 5. Then recorded the HR, MBP, pH, PaCO2at Ta（pre-anesthesia） ,Tt （end of the first apnea ）, T2 （ end of the second apnea ）, T3 （ end of the third apnea ）, T4 （ end of the fourth apnea ）, T5 （ end of the fifth apnea ） and Tb （15 minutes after operation）. Results There were no satistically significant differences of HR, MBP, pH, PaCO2at Ta, T1 - T5 （P 〉0.05） ; and there were no satisticaUy significant differences of tra- cheal extubation time and orientation recovery time（ P 〉0.05）. The pH was lower at T1 - T5 than at Ta （P 〈 0.05） ,but the pH raised closing to the normal level at Tb. The PaCO2was higher at T1 - T5 than at Ta（P 〈 0. 05 ）, but the PaCO2 declined closing to the normal level at TbThe PaO2 wAwas lower at T1 - T5 than at Ta （P 〈 0.05）, but the lowest value was higher than 380 mmHg. Conclusions The apneic anesthesia with inter- mittent ventilation can be applied safely and efficienty during anaesthesia in pediatric holmium laser lithoclasty with flexible ureteroscope.