日间漏斗胸Nuss术后钢板取出术患儿围术期麻醉效果观察

Oberservation on the effect of perioperative anesthesia in children with metal bar removal after Nuss daytime surgery of funnel chest

目的探讨日间漏斗胸Nuss术后钢板取出术患儿围术期麻醉效果。方法选取2022—2023年首都医科大学附属北京儿童医院计划按照日间手术管理模式行漏斗胸Nuss术后钢板取出术患儿,收集患儿一般资料和临床资料,观察术中、术后患儿不良事件和恢复情况。结果共纳入377例患儿,其中男286例、女91例;年龄6~18岁,平均(13.0±3.6)岁,体质量(45.3±14.6)kg;美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级Ⅰ或Ⅱ级,均采用全身麻醉,麻醉诱导后置入气管插管33例,置入喉罩344例,术中出血量为(2.2±1.2)ml,手术时间(40.0±20.9)min,麻醉时间(56.7±22.5)min,停药至拔管时间(8.1±3.0)min,麻醉恢复室停留时间(13.0±2.9)min;术中均未出现低氧血症、高血压、低血压、心动过速、心动过缓、心律失常、术中知晓等不良事件;术后均未出现苏醒延迟、呼吸抑制、低氧血症、严重咽喉部不适、中重度疼痛、恶心呕吐、气胸、伤口出血或血肿等不良事件。结论日间漏斗胸Nuss术后钢板取出术患儿的手术操作时间短、手术及麻醉相关并发症少。术前麻醉门诊完成患儿全面评估和筛选、术中配合外科医生进行肺复张操作,术后早期识别因气胸引起的低氧血症,可提高日间漏斗胸Nuss术后钢板取出术患儿的术后恢复效果。

Objective To explore the perioperative anesthetic effect of children with metal bar removal after Nuss daytime surgery of funnel chest.Methods Children who were scheduled to undergo metal bar removal after Nuss daytime surgery of funnel chest in Beijing Children's Hospital Affiliated to Capital Medical University from 2022 to 2023 were collected,the general and clinical data of children were collected,and the adverse events and recovery of children during and after operation were observed.Results A total of 377 patients were selected,including 286 males and 91 females,and aged from 6 to 18 years,with an average of(13.0±3.6)years,the weight was(45.3±14.6)kg,American Society of Anesthesiologists(ASA)grade were I or II,and all of them were under general anesthesia.After anesthesia induction,33 cases were implanted with tracheal intubation and 344 cases with laryngeal mask.The intraoperative blood loss was(2.2±1.2)ml,the operative time was(40.0±20.9)min,the anesthetic time was(56.7±22.5)min,the time from drug withdrawal to extubation was(8.1±3.0)min,and postanesthesia care unit residence time was(13.0±2.9)min.There were no adverse events during operation such as hyoxemia,hypertension,hypotension,tachycardia,bradycardia,arrhythmia,or intraoperative awareness.There were no adverse events after operation such as delayed recovery,respiratory depression,hyoxemia,severe throat discomfort,moderate to severe pain,nausea and vomiting,pneumothorax,wound bleeding or hematoma.Conclusions The operation time of metal bar removal after Nuss daytime surgery of funnel chest is short,and the complications related to surgery and anesthesia are few.It is suggested to complete the comprehensive evaluation and screening of children in anesthesia clinic before daytime surgery,cooperate with the surgeon to perform lung recruitment operation during operation,and identify hypoxemia caused by pneumothorax early after operation to improve the postoperative recovery effect of children undergoing metal bar removal after Nuss daytime surgery of funnel chest.