儿童危重气管支气管异物的气道管理及麻醉方法

Airway management and anesthesia method for children with severe tracheobronchial foreign body

目的探讨危重气管、支气管异物患儿硬质气管镜检查术中的气道管理及麻醉方法。方法回顾性分析2012年1月至2016年6月共收治的34例危重气管、支气管异物患儿的诊治资料,包括入室(T1)、麻醉诱导后(T2)、支气管镜进入声门后(T3)及退镜后(T4)的HR、SpO_2,观察术中有无肢动、呛咳、喉痉挛及呕吐误吸等情况,并记录术前及术后2 h血气分析结果。结果 T2、T3、T4与T1比较患儿HR减慢,差异有统计学意义(P <0. 05),T4与T1比较SpO_2升高,差异有统计学意义(P <0. 05)。术后2h PaO_2、SaO_2较术前升高,差异有统计学意义(P <0. 05);术后2hPaCO_2较术前下降,差异有统计学意义(P <0. 05)。2例(5. 9%)患儿麻醉诱导时出现呕吐,4(11. 8%)例患儿在术中出现肢动及呛咳,全部患儿一次手术成功取出异物,无严重喉及气道痉挛发生,无麻醉意外情况发生。结论硬质气管镜检查术中麻醉医师需要根据呼吸困难程度采用不同的麻醉方案,保证充分氧供,避免胃内容物误吸、气道痉挛,协助耳鼻喉医师尽快解除气道梗阻,是抢救成功、降低的病死率的关键。

Objective To investigate the airway management and anesthesia methods in examination of stereoplasm bronchoscope for children with severe tracheobronchial foreign body. Methods The data of 34 children patients with severe trachea and bronchial foreign body who were admitted and treated from January 2012 to June 2016 were retrospective analyzed.The HR and SpO2 were recorded at entering the operation room（ T1）,after induction of anesthesia（ T2）,after the time of placing tracheoscope into glottis（ T3） and after the time of taking out the tracheoscope（ T4）. And the limb movement,choke cough,laryngospasm and vomiting were observed at the same time. The arterial blood gas analysis results before operation and two hours after operation were recorded. Results The HR of patients at T2,T3,T4 was significantly lowered,as compared with that at T1（ P < 0. 05）. The SpO2 at T4 was significantly increased,as compared with that at T1（ P < 0. 05）. The PaO2,SaO2 at 2 h after operation were significantly increased,as compared with those before operation（ P < 0. 05）. Moreover the Pa CO2 at 2 h after operation were significantly decreased,as compared with those before operation（ P < 0. 05）. The 2 patients（ 5. 9%） had vomiting during anesthesia induction,and 4 patients（ 11. 8%） had limb movement and choke cough during operation. The foreign bodies were successfully taken out one time in all the patients,moreover no severe spasm of laryngeal and airway were found,in addition no anesthetic accidents were observed. Conclusion It is necessary for anesthesiologists to apply different anesthetic schemes in examination of stereoplasm bronchoscope according to the degree of expiratory dyspnea of patients. Ensuring adequate oxygen supply, avoiding gastric contents inhalation and airway spasm, and assisting otolaryngologists to relieve airway obstruction as soon as possible are the key to rescue successfully and reduce mortality rate.