1、238 例气道异物的麻醉：肌松控制呼吸或保留自主呼吸？佘应军 谭永红 刘大波 王怀贞 张国强 刘艳辉 谭宗喻(广州市妇女儿童医疗中心儿童院区麻醉科 广东广州 510120)摘要 目的：气道异物是临床上常见且危及小儿安全的疾病，需要在全麻下取异物。术中的关键是维持足够的有效通气。保留自主呼吸与控制呼吸都被成功的应用临床上，并取得了良好的效果，但没有定论。本文比较术中手控控制呼吸与保留自主呼吸两种技术在硬支气管镜手术中的应用。方法：选择住院行支气管镜手术 238 例，根据术中不同的通气方式分为两组：保留自主呼吸组（S 组）保留自主呼吸并高频通气辅助，采用异丙酚，氯胺酮，芬太尼诱导。控制呼吸组（C
2、组）采用 Mapleson B 行手控控制通气，麻醉诱导:异丙酚，芬太尼，维库溴胺。记录术中相关呼吸道并发症，手术时间，复苏时间，血流动力学变化，并记录术后并发症等。结果 C 组的手术时间以及麻醉恢复时间相比 S 组明显减少，有统计差别（P0.001） 。术中屏气，呛咳，支气管痉挛等 S 组发生率明显高于 C 组（P0.001） 。S 组中发生低氧的小儿明显多于 C 组（P0.001） 。血流动力学变化 C 组比 S 组平稳。术后两组小儿发烧病例（S:C=43:50,P0.759）没有明显差别，术后住院天数 S 组要长于 C 组（S:C=41:3.50.5, P0.001）.结论 肌松控制呼吸
3、并联合使用 Mapleson B 环路可以提供良好的手术条件和平稳的麻醉深度，应被推荐为气道异物手术中首选的麻醉方法。【关键词】 异物；气道；控制呼吸；呼吸环路Anesthesia for removal of airway foreign bodies in 238 children: hand-controlled ventilation using a type B breathing circuit VS spontaneous ventilation with high frequency Jet VentilationBackground: Foreign bodies are a
4、 life-threating event in children that require immediate bronchoscopy under general anesthesia. Maintaining adequate ventilation is a key point during anesthesia for bronchoscopy, both spontaneous and controlled ventilation technique have been successfully used for it, there are still subjects of di
5、scussion on the choice of controlled or spontaneous ventilation. We reported our experience on foreign body management, and compared spontaneous and controlled ventilation during anesthesia for removal of foreign bodies in children.Methods: 238 children undergoing rigid bronchoscopy for suspect fore
6、ign body were assessed. According to different ventilation technique during anesthesia for bronchoscopy, they were allocated to spontaneous group（S ） or controlled group(C).Relevent intraoperation complication and haemodynamics, operation and recovery time were compared. In spontaneous group, induct
7、ion and maintenance of anesthesia were performed by intravenous drugs associated with typical airway lidocaine under spontaneous ventilation. In controlled group, these were performed by intravenous drug associated with muscle relaxant under hand controlled ventilation with a type B breathing circui
8、t.Results: there were a significant higher incidence of intraoperative complications such as desaturation, breathholding, coughing and bucking, bronchospasm in spontaneous ventilation compared with controlled group(P0.001). the operative and recovery time during bronchoscopy had significantly reduce
9、d in controlled group(P0.001). there were a more stable haemodynamics in controlled group compared with spontaneous group(P0.05).Conclusion: the use of hand controlled ventilation by a type B breathing circuit with muscle relaxant and intravenous anesthesia is the perferred choice of anesthesia for removal of foreign bodies in children.Key words foreign body, Tracheobronchial, controlled ventilation, breathing circuit
