肺大泡自发性气胸手术麻醉处理——附28例临床分析

Anesthesia management in operation for spontaneous pulmonary bulla pneumothorax

目的 探讨肺大泡自发性气胸病人在麻醉期间的危险性及预防措施。方法 为了预防麻醉诱导和维持期间的肺大泡破裂 ,本组麻醉诱导面罩吸氧应用手法控制呼吸囊辅助通气和控制通气时 ,轻压呼吸囊 ,使胸廓略有起伏 ,血氧饱和度在基础状态下逐渐上升 ,同时监测气道压力 ,使气道压不超过 2 0cmH2 O(1.96kPa)。以SpO2 平稳上升为手法控制呼吸囊的适宜程度 ,同时选用双腔管插管。结果 本组 2 8例肺大泡自发性气胸在麻醉期间无 1例出现麻醉期间肺大泡破裂。结论 对此类病人选用全麻快速诱导 ,双腔管插管 ,手法控制通气量 ,严密监测Sp0 2和气道压 ,可防止肺大泡破裂。

Objective We aimed to explore the risks in operation for spontaneous pulmonary bulla pneumothorax and the measures for preventing bulla rupture. Methods The authors collected 28 cases with spontaneous pulmonary bulla pneumothorax. Oxygen mask was connected to manually controlled respiratory balloon for assisted ventilation during anesthesia induction. We gently pressed the balloon to slightly expand the thorax. SpO 2 gradually rose from basal status. Airway pressure was simultaneously conditioned to ≤20cmH 2O(1.96kPa).Respiratory balloon was manually controlled to the extent when SpO 2 rose smoothly. With double-channel catheter inserted at the same time. Results None of the patients suffered from pulmonary bulla rupture. Conclusion Pulmonary bulla rupture could be prevented by general anesthesia.Rapid induction. Insertion with double channel catheter. Manually controlling ventilation voulume. And carefully monitoring SpO 2 as well as airway pressure.