两种基础麻醉下经鼻腔纤支镜导引处理小儿困难气道插管的比较

梁启胜; 凌云志; 代文涛; 朱琳琳

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两种基础麻醉下经鼻腔纤支镜导引处理小儿困难气道插管的比较

梁启胜 , 凌云志 , 代文涛 , 朱琳琳

文章导航 > 蚌埠医学院学报 > 2011, 36 > 3: (242-245)

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两种基础麻醉下经鼻腔纤支镜导引处理小儿困难气道插管的比较

蚌埠医学院第一附属医院麻醉科, 安徽蚌埠 233004

作者简介: 梁启胜(1964-),男,主任医师.

中图分类号: R472.9

Comparison of two kinds of basal anesthesia in pernasal endotracheal intubation through fiberbronchoscope for difficult intubation in children

Department of Anesthesiology, The First Affiliated Hospital of Bengbu Medical College, Bengbu Anhui 233004, China
CLC number: R472.9

摘要: 目的: 探讨小儿困难气管插管的插管前准备、基础麻醉方法、纤维支气管镜(纤支镜)引导插管技巧。方法: 对23例困难插管患儿行充分术前镇静,随机分为氯胺酮组(A组)10例,七氟烷组(B组)13例,均行基础麻醉、鼻腔黏膜收敛和表面麻醉,经鼻纤支镜导引插管,观察其成功率及并发症发生情况。结果: 23例插管均成功,插管时间(11.8 ±2.4)min,插管操作(包括易手插管)1~3次,术毕即时拔管15例,在麻醉恢复室恢复后拔管8例;气管插管中3例出现喉痉挛、上呼吸道梗阻、氧饱和度(SaO₂)迅速下降,随即停止操作,面罩吸氧改善后重新插管;术后轻度声音嘶哑2例,经雾化吸入无后遗症。2组插管过程中皆出现SaO₂下降,心率增快,平均动脉压升高,尤以完成插管操作时为甚,且A组更为显著(P<0.05~P<0.01)。结论: 插管前准备充分,七氟烷基础麻醉经鼻纤支镜导引插管处理小儿困难气道,插管成功率高,损伤小,并发症少。
- 插管法 /
- 七氟烷 /
- 基础麻醉 /
- 纤维支气管镜
Abstract: Objective: To observe the safety and effectiveness after the management of pre-anaesthetic,basal anaesthetic methods and intubation technique by fiberbronchoscope for difficult airway in children. Methods: Twenty-three children with difficult airway were sedated before operation and randomly separated into ketamine group (group A,10 cases) and sevoflurane group (group B,13 cases). Based anesthesia,nasal mucosa convergence,surface anesthesia and nasal fiberoptic guided intubation were applied to these children. The ratio of success and the complications during this period were recorded. Results: Twenty-three cases were successfully intubated. The average time of tracheal intubation was (11.8 ±2.4) min. The times of intubation (including changing hands) were 1-3. Fifteen cases could be extubated just when operation finished and eight cases could be extubated after operation in PACU. Three patients appeared apnea,upper airway obstruction and oxygen saturation decreased rapidly during intubation. Immediately stopping operation and intubated again when oxygen masks were given. Two cases appeared mild hoarseness after surgery and no after-effects by inhalation. There were SaO 2 lower,heart rate and mean artery pressure increased in two groups during intubation,especially in group A (P<0.05 to P<0.01). Conclusions: Well-prepared before intubation and sevoflurane based anesthesia treatment of nasal fiberoptic guided intubation in children with difficult airway,the success rate of intubation is high with little damage and few complications.
- intubation /
- sevoflurane /
- basal anesthesia /
- fiberbronchoscopy

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两种基础麻醉下经鼻腔纤支镜导引处理小儿困难气道插管的比较

作者简介: 梁启胜(1964-),男,主任医师.

蚌埠医学院第一附属医院麻醉科, 安徽蚌埠 233004

收稿日期: 2010-05-31

关键词:

摘要: 目的: 探讨小儿困难气管插管的插管前准备、基础麻醉方法、纤维支气管镜(纤支镜)引导插管技巧。方法: 对23例困难插管患儿行充分术前镇静,随机分为氯胺酮组(A组)10例,七氟烷组(B组)13例,均行基础麻醉、鼻腔黏膜收敛和表面麻醉,经鼻纤支镜导引插管,观察其成功率及并发症发生情况。结果: 23例插管均成功,插管时间(11.8 ±2.4)min,插管操作(包括易手插管)1~3次,术毕即时拔管15例,在麻醉恢复室恢复后拔管8例;气管插管中3例出现喉痉挛、上呼吸道梗阻、氧饱和度(SaO₂)迅速下降,随即停止操作,面罩吸氧改善后重新插管;术后轻度声音嘶哑2例,经雾化吸入无后遗症。2组插管过程中皆出现SaO₂下降,心率增快,平均动脉压升高,尤以完成插管操作时为甚,且A组更为显著(P<0.05~P<0.01)。结论: 插管前准备充分,七氟烷基础麻醉经鼻纤支镜导引插管处理小儿困难气道,插管成功率高,损伤小,并发症少。

English Abstract

Comparison of two kinds of basal anesthesia in pernasal endotracheal intubation through fiberbronchoscope for difficult intubation in children

Department of Anesthesiology, The First Affiliated Hospital of Bengbu Medical College, Bengbu Anhui 233004, China

Received Date: 2010-05-31

Abstract: Objective: To observe the safety and effectiveness after the management of pre-anaesthetic,basal anaesthetic methods and intubation technique by fiberbronchoscope for difficult airway in children. Methods: Twenty-three children with difficult airway were sedated before operation and randomly separated into ketamine group (group A,10 cases) and sevoflurane group (group B,13 cases). Based anesthesia,nasal mucosa convergence,surface anesthesia and nasal fiberoptic guided intubation were applied to these children. The ratio of success and the complications during this period were recorded. Results: Twenty-three cases were successfully intubated. The average time of tracheal intubation was (11.8 ±2.4) min. The times of intubation (including changing hands) were 1-3. Fifteen cases could be extubated just when operation finished and eight cases could be extubated after operation in PACU. Three patients appeared apnea,upper airway obstruction and oxygen saturation decreased rapidly during intubation. Immediately stopping operation and intubated again when oxygen masks were given. Two cases appeared mild hoarseness after surgery and no after-effects by inhalation. There were SaO 2 lower,heart rate and mean artery pressure increased in two groups during intubation,especially in group A (P<0.05 to P<0.01). Conclusions: Well-prepared before intubation and sevoflurane based anesthesia treatment of nasal fiberoptic guided intubation in children with difficult airway,the success rate of intubation is high with little damage and few complications.