斜方肌挤压与托下颌实验在小儿支气管异物取出术麻醉中的应用

Comparision of the Trapezius Squeezing Test and Jaw Thrust Test in Tracheobronchial Foreign Body Removal Surgery in Children

目的比较斜方肌挤压与托下颌实验评价小儿支气管异物取出术中麻醉深度的效果。方法拟急诊行支气管异物取出术患儿60例,年龄11~36个月,ASA分级Ⅱ~Ⅲ级,随机分为斜方肌挤压实验组(T组)和托下颌实验组(J组),每组30例。60例患儿均采用6 L·min^(-1)氧气及6%七氟烷吸入麻醉诱导及瑞芬太尼[0.2~0.5μg·(kg·min)^(-1)]静脉持续泵入,至睫毛反射消失后,斜方肌挤压实验组(T组)每15 s挤压1次斜方肌,待斜方肌挤压实验阴性行喉镜直视下喉黏膜表面麻醉,托下颌实验组(J组)每15 s拖1次下颌,待患儿无体动行喉镜直视下表面麻醉(1%丁卡因)。记录并比较两组患儿喉镜直视下表面麻醉及硬性支气管镜置入成功率、置入喉镜表面麻醉和置入硬性支气管镜时屏气、呛咳、体动及低氧血症发生率,比较两组喉镜置入前(T0)及表面麻醉后1 min(T1)、2 min(T2),硬性支气管镜置入后1 min(T3)、2 min(T4)患儿血压、心率、脉搏氧饱和度的变化。结果60例患儿均在保留自主呼吸下完成手术。斜方肌挤压实验组患儿喉镜置入喉黏膜表面麻醉时屏气、低氧血症发生率均低于J组(P均<0.05);T组患儿1次置入喉镜喉喷成功率和1次置入硬性气管镜成功率高于J组(P均<0.05)。两组患儿诱导期间均无低氧血症发生,T组患儿喉喷后1 min及硬性支气管镜置入1 min SpO_(2)高于J组(P均<0.05)。两组患儿手术时间差异无统计学意义(P>0.05)。结论斜方肌挤压实验较托下颌实验能更好的指导小儿支气管异物取出术的麻醉深度。

Objective To compare the effect of trapezius squeezing test and jaw thrust test in pediatric patients undergoing bronchial foreign body removal surgery.Methods Sixty pediatric patients,aged 11-36 months,undergoing emergency bronchial foreign body removal surgery,were divided randomly into 2 groups(n=30):trapezius squeezing test group(group T)and jaw thrust group(group S).Patients in both group were inducted with oxygen 6%and sevoflurane 6%inhalation combined with remifentanil continuous intravenous infusion[0.2-0.55μg·(kg·min)^(-1)].Two groups of patients breathed spontaneously during operative period and received topical anesthesia of tetracaine hydrochloride before the placement of rigid bronchoscopy.When children’s eyelash reflex lose,jaw thrust/trapezius squeeze was applied every 15 seconds.It’s considered that the depth of anesthesia was not enough,and test reaction was positive if any movements of body,limbs or toes were found at the point of test.Sevoflurane should be kept on inhalation until before bronchoscopy insertion.The rigid bronchoscopy was performed 2 mins after topical anesthesia of tetracaine hydrochloride.The occurrence of gross purposeful movements,coughing,breath-holding or hypoxemia(SpO_(2)<90%)during laryngoscope and bronchoscopy insertion in two groups of patients were observed and recorded.The condition of laryngoscope and bronchoscopy insertion and the rate of successful insertion were evaluated.The blood pressure(BP),heart rate(HR)and SpO_(2) were also recorded before laryngoscope insertion(T0)、after topical anesthesia 1 min(T1)、2 mins(T2)and after bronchoscopy insertion 1 min(T3)、2 mins(T4).Results All patients were spontaneously ventilating,and had successful airway foreign body removal surgery.The breath holding and hypoxemia occurred in group T were significantly higher than group J(P all<0.05).The rate of successful laryngoscope and bronchoscopy were higher than J group(P<0.05).The SpO_(2) of T1 and T3 in group T is significantly higher than group J(P all<0.05).Conclusion The trapezius squeezing test is a superior indicator of adequate condition compared to the jaw thrust in tracheobronchial foreign body removal surgery under sevoflurane anesthesia spontaneous ventilation.