高频辅助自主呼吸下七氟烷复合瑞芬太尼在586例小儿气道异物取出术中的应用

Application of sevoflurane and remifentanil under spontaneous respiration assisted with high-frequency jet ventilation for tracheobronchial foreign body removal

目的气道异物常常危及患儿的生命。气管支气管异物通常在全身麻醉下使用硬质支气管镜取出。不同的医院和麻醉医生所用的麻醉方法和通气技术差别较大。笔者在回顾性研究中报道了五年多气道异物取出的麻醉经验。对发生的并发症和预后及麻醉与通气技术的临床特点进行了分析和总结。方法笔者对在全身麻醉下运用硬质支气管镜取气管支气管异物的586例患儿的相关临床结果进行了回顾性分析。所有气道异物的取出均在七氟烷吸入联合瑞芬太尼静脉泵注,高频通气辅助自主呼吸和充分的表面麻醉下进行。结果 586例患儿中,558例气道异物成功取出,28例术中未发现异物。5例发生喉痉挛。15例出现低氧血症(2.6%)。无严重并发症及无1例死亡。平均手术时间22 min,平均住院日2天。结论充分的表面麻醉加高频辅助自主呼吸下七氟烷吸入复合瑞芬太尼静脉泵注是小儿气道异物取出术安全有效的麻醉方法。

Objective To analyze and summarize the clinical characteristics of anesthesia by sevoflurane and remifentanil under spontaneous respiration assisted with high-frequency jet ventilation for tracheobronchial foreign body removal.Methods We retrospectively reviewed relevant clinical findings of 586 pediatric patients treated with rigid tracheobronchoscopy under general anesthesia.All procedures were performed under inhaled sevoflurane anes-thesia combined with remifentanil infusion,with spontaneous respiration assisted by high-frequency jet ventilation （HFJV）and topical airway anesthesia.Results Among 586 patients,the foreign body was successfully removed by rigid tracheobronchoscopy in 558 patients,and no foreign body was found in 28 patients.Laryngospasm was observed during the procedure in 5 patients.Hypoxemia was observed in 1 5 patients （2.6%）.No severe complications or death occurred.The mean operation time was 22 min and the average duration of hospital stay was 2 days.Conclu-sion Inhaled sevoflurane anesthesia combined with remifentanilinfusion,with spontaneous respiration assisted by HFJV and topical airway anesthesia,is a safe and effective method for tracheobronchial foreign body removal.