静脉麻醉辅以高频喷射通气在保留自主呼吸的小儿气道异物取出术的应用

Application of intravenous anesthesia supplemented with high-frequency jet ventilation in pediatric airway foreign body removal with preservation of spontaneous breathing

目的:探究静脉麻醉辅以高频喷射通气辅助呼吸在保留自主呼吸的小儿气道异物取出术的应用效果。方法:选取赣州市人民医院2018年1月—2022年12月接收的60例拟行经硬支气管镜气道异物取出术的患儿,按麻醉方案分为对照组及高频喷射通气组。2组患儿进入手术室后先经面罩加压吸入七氟醚行麻醉诱导,其后立即用利多卡因行口咽腔及气管内表面麻醉。对照组患儿在表面麻醉后静脉泵入丙泊酚(2 mg·mL^(-1))0.1 mg·(kg·min)^(-1)、瑞芬太尼(2µg·mL^(-1))0.1µg·(kg·min)^(-1),同时将右美托咪定(2µg·mL^(-1))以2µg·kg^(-1)的负荷剂量在10 min内匀速泵完,然后调整泵速为1µg·(kg·h)^(-1)至手术结束;高频喷射通气组在对照组的基础上于手术开始时辅以高频喷射通气。比较2组患儿手术时间、术后苏醒时间及术前术后脉搏氧饱和度(SpO_(2));观察比较2组患儿吸入麻醉诱导前(T_(0))、用利多卡因行口咽腔及气管内表面麻醉后20 min(T_(1))、第一次置入硬支气管镜后1 min(T_(2))、第一次置入硬支气管镜后5 min(T_(3))2组患者的心率(HR)、平均动脉压(MAP)、呼吸频率(RR)、SpO_(2);比较2组患儿围术期各种不良反应发生情况。结果:2组患儿手术时间、苏醒时间比较差异无统计学意义(P>0.05)。2组术前的PaCO_(2)比较差异无统计学意义(P>0.05);2组患儿术后的PaCO_(2)比较差异有统计学意义(P<0.05)。2组患者组间比较,T_(0)、T_(1)、T_(2)时刻的HR、MAP、RR、SpO_(2)比较差异无统计学意义(P>0.05),但在T3时刻高频喷射通气组的SpO_(2)更高,同时高频喷射通气组明显呼吸抑制的发生率更低(P均<0.05)。2组患儿均未观察到恶心、躁动、喉痉挛、支气管痉挛、心动过速、心动过缓的发生,2组患儿呛咳、屏气发生率差异无统计学意义(P>0.05),对照组比高频喷射通气组呼吸抑制的发生率更高,差异有统计学意义(P<0.05)。结论:在保留自主呼吸的小儿气道异物取出术静脉麻醉时辅以高频喷射通气可以使呼吸功能较好地保留,同时血流动力学平稳、各种不良反应的发生率均较低,是一种较为安全、可靠的麻醉方法。

Objective:To investigate the application effect of intravenous anaesthesia supplemented with high-frequency jet ventilation assisted respiration in pediatric airway foreign body removal with preservation of spontaneous breathing.Methods:Sixty cases of proposed rigid bronchoscopic airway foreign body removal surgery received by Ganzhou People's Hospital from January 2018 to December 2022 were randomly and evenly divided into the control group and the high-frequency jet ventilation group,following the anaesthesia protoctol.The two groups of children entered the operating room for anaesthesia induction first by mask-pressure inhalation of sevoflurane,and then surface anaesthesia of oropharyngeal and endotracheal cavities with lidocaine was immediately performed thereafter.In the control group,after surface anaesthesia,propofol(2 mg·mL^(-1))0.1 mg·(kg·min)^(-1) and remifentanil(2µg·mL^(-1))0.1µg·(kg·min)^(-1) were pumped intravenously,while dexmedetomidine was pumped at a loading dose of 2µg·kg^(-1) for 10 min at an even rate,and then the pumping rate was adjusted to 1µg·(kg·h)^(-1) until the end of surgery.The high-frequency jet ventilation group was supplemented with high-frequency jet ventilation at the beginning of surgery on the basis of the control group.The heart rate(HR),mean arterial pressure(MAP),respiratory rate(RR),and pulse oximetry(SpO_(2))of the patients between the two groups were compared before the induction of inhalation anaesthesia(T_(0)),20 min after the administration of oropharyngeal and endotracheal surface anaesthesia with lidocaine(T_(1)),1 min after the first placement of the endobronchoscope(T_(2)),and 5 min after the first placement of the endobronchoscope(T_(3)).The occurrence of various perioperative adverse reactions,the operation time and postoperative awakening time between the two groups were also compared.Results:There was no significant difference in operation time and recovery time between the two groups(P>0.05).There was no significant difference in PaCO_(2) between the two groups before operation(P>0.05).There was significant difference in PaCO_(2) between the two groups after operation(P<0.05).When comparing the two groups of patients,the differences in HR,MAP,RR,and SpO_(2) at the moments of T_(0),T_(1),and T_(2) were not statistically significant(P>0.05),but at the moment of T_(3) the SpO_(2) was higher in the high-frequency jet ventilation group.And the incidence of significant respiratory depression was much lower in the high-frequency jet ventilation group(P<0.05).No nausea,agitation,laryngeal spasm,bronchospasm,tachycardia and bradycardia were observed in the two groups,and there was no statistical significance in the incidence of coughing and breath-holding between the two groups(P>0.05).The incidence of respiratory depression in the control group was higher than that in the high-frequency jet ventilation group,with statistical significance(P<0.05).Conclusion:The supplementation of high-frequency jet ventilation during intravenous anesthesia for pediatric airway foreign body removal with preservation of spontaneous respiration can achieve better preservation of respiratory function,as well as smooth hemodynamics,with a lower incidence of various adverse effects,making it a safer and more reliable anesthesia method.