经球囊扩张管侧管通气法在无气管造口的全身麻醉患儿行气道球囊扩张术中的应用

Application of lateral tube ventilation in children with non-tracheotomy undergoing airway balloon dilation during general anesthesia

目的 回顾性分析经球囊扩张管侧管通气法用于无气管造口的全身麻醉患儿行气道扩张术的临床效果及安全性。方法 收集2019年12月—2020年6月在上海市儿童医院择期或急诊行支撑喉镜下气道球囊扩张术的19例中度获得性声门下狭窄患儿的临床资料,根据术前有无气管造口分为气管造口组(11例)和无气管造口组(8例)。无气管造口组在给予常规气管插管麻醉后,应用与球囊扩张管侧管相连的气管导管控制通气;气管造口组则通过气管造口管理呼吸。记录两组患儿麻醉诱导前(T_(1))、球囊扩张导管置入前(T_(2))、球囊扩张导管扩张中(T_(3))、球囊扩张后恢复正常通气时(T_(4))的血流动力学指标[心率、平均动脉压(MAP)、经皮动脉血氧饱和度(SpO_(2))]和呼气末二氧化碳浓度(EtCO_(2))。记录术中、术后两组患儿不良反应(喉痉挛、支气管痉挛、术后苏醒延迟、再次气管插管或需留置气管导管)发生情况。结果 两组间患儿各时间点心率、MAP、SpO_(2)的差异均无统计学意义(P值均>0.05)。两组患儿各时间点间心率、MAP、SpO_(2)的差异均无统计学意义(P值均>0.05)。两组间T_(1)、T_(2)时间点EtCO_(2)的差异均无统计学意义(P值均>0.05);无气管造口组T_(3)时间点EtCO_(2)显著低于气管造口组同时间点(P<0.05),T_(4)时间点EtCO_(2)显著高于气管造口组同时间点(P<0.05)。气管造口组各时间点间EtCO_(2)的差异均无统计学意义(P值均>0.05);无气管造口组T_(3)时间点的EtCO_(2)显著低于同组T_(1)、T_(2)时间点(P值均<0.05),T_(4)时间点的EtCO_(2)显著高于同组T_(1)、T_(2)时间点(P值均<0.05)。两组均无1例患儿发生喉、支气管痉挛和苏醒延迟,无气管造口组患儿无1例需再次行气管插管或留置气管导管。结论 无气管造口的患儿在行气道球囊扩张术中,球囊扩张管的侧管可安全、有效地对无自主呼吸患儿进行全身麻醉下的控制通气。

Objective To retrospectively analyze the clinical outcome and safety of lateral tube ventilation for non-tracheostomy in children undergoing airway balloon dilation during general anesthesia.Methods Clinical data of 19 children with medium acquired subglottic stenosis undergoing elective or emergency airway balloon dilation in Shanghai Children’s Hospital from December 2019 to June 2020 were collected.The tracheostomy was applied to manage breathing in 11 patients(tracheotomy group).A tracheal tube was connected to the side tube of the balloon dilatation tube to control ventilation after conventional tracheal intubation in 8 patients(non-tracheostomy group).The heart rate,mean arterial pressure(MAP),pulse oxygen saturation(SpO_(2))and end-expiratory carbon dioxide concentration(EtCO_(2))were recorded before anesthesia induction(T_(1)),before balloon dilation catheter placement(T_(2)),during balloon dilation(T_(3)),and when normal ventilation was restored after balloon dilation(T_(4)).The occurrence of adverse reactions,such as laryngeal spasm,bronchospasm,delayed recovery,repeated intubation,and tube-detaining,were recorded during and after surgery.Results There were no significant differences in heart rate,MAP or SpO_(2) at any time point between the two groups(all P>0.05).There were no significant difference in heat rate,MAP or SpO_(2) between different time points in the group(all P>0.05).There were no significant differences in EtCO_(2) at T_(1) and T_(2) between the two groups(both P>0.05).The EtCO_(2) in the non-tracheotomy group was significantly lower than that in thetracheostomy group at T_(3)(P<0.05),while the EtCO_(2) in the non-tracheostomy group was significantly higher than that in thetracheostomy group at T_(4)(P<0.05).In the tracheostomy group,no significant difference was found in EtCO_(2) between different time points(P>0.05).In the non-tracheostomy group,compared with that at T_(1) and T_(2),the EtCO_(2) was significantly decreased at T_(3),but significantly increased at T_(4)(all P<0.05).No laryngeal spasm,bronchospasm,delayed recovery,repeated intubation,or tube-detaining occurred.Conclusion It is effective and safe to ventilate by the lateral tube of the balloon dilatation during general anesthesia in children without tracheostomy and spontaneous breathing.