经Frova手控喷射通气在小儿声门下乳头状瘤切除术中的应用

The effect of manual jet ventilation via Frova for subglottic papilloma resection in pediatric patients

目的 比较经Frova插管导入器（简称Frova）行手控喷射通气和传统间断气管插管通气在内窥镜吸割器切除患儿声门下乳头状瘤术中的应用效果.方法 40例需行内窥镜吸割器切除声门下乳头状瘤的患儿,年龄4～12岁,ASA Ⅱ或Ⅲ级,随机数字表法分为两组,每组20例.Ⅰ组在声门下乳头状瘤切除时段内采用传统的间断气管插管通气;F组在相同时段内采用Frova（8.0Fr/35cm）行手控喷射通气.手术结束两组均插入合适的气管导管控制通气直至苏醒.记录手术结束即刻患儿血流动力学和呼吸指标,记录外科医师对术野和操作便利的满意度评分、声门下乳头状瘤切除的持续时间、总的麻醉时间、苏醒时间及不良反应.结果 在手术结束即刻Ⅰ组的PErCO2明显高于F组（P＜0.01）,SpO2明显低于F组（P＜0.01）;苏醒时间Ⅰ组明显长于F组（P＜0.01）;外科医师对视野和操作便利的满意度F组优于Ⅰ组（P＜0.05）;两组患儿无明显气道不良反应.结论 使用Frova进行手控喷射通气在内窥镜吸割器切除4～12岁小儿声门下乳头状瘤时不但能保障氧供、防止CO2蓄积,而且能提供较好的手术视野,是一种良好的通气管理方式.

Objective To compare the safety and efficacy of manual jet ventilation via Frova with intermittent tracheal tube ventilation for subglottic papilloma resection in pediatric patients.Methods Forty pediatric patients,aged 4-12 years,undergoing laryngeal papilloma resection,were randomly assigned to two groups：intermittent tracheal tube ventilation （group Ⅰ,n=20） and manual jet ventilation via Frova （group F,n=20）.In group Ⅰ,to facilitate subglottic papilloma resection patients were extubated and without ventilation until SpO2 decrease to 90 ％,then reintubation to ventilate to SpO2 up to 100％,and that cycle repeats.In group F,patients were ventilated with manual jet ventilation via Frova （8.0 Fr/35 cm）.At the end of the surgery,all patients had tracheal intubation for control ventilation until emergence.We recorded hemodynamic and respiratory profiles at the end of the surgery.The surgeons scored concerning surgery field exposure and facilitation of surgery.Duration of subglottic papilloam resection,anesthesia,and emergence time were of interest.Incidence of airway complications was also noted.Results General demographics were similar between two groups.At the end of the surgery,compared to group Ⅰ,group F had higher SpO2 and lower PErCO2 （P＜0.01）.Compare with group Ⅰ,the emergence time was shorter（P＜0.01）,the surgeons scored was higher（P＜0.05） in group F.No severe airway complications were observed in both groups.Conclusion Manual jet ventilation via Frova could provide not only appropriate ventilation and oxygen supply,but better surgery field exposure,this ventilation mode is efficacious for subglottic papilloam resection in pediatric patients.