喉罩在小儿气管异物取出术中的应用 - 第三军医大学学报.doc

自制三通喉罩通气在纤支镜小儿气管异物取出术的应用 杨天明， 胡 赟， 陈伯成， 全超坤 ( 解放军第三0三医院麻醉科，广西 南宁市 530021 ) 摘要： 目的 探讨自制三通喉罩通气在纤维支气管镜小儿支气管镜气管、支气管异物取出术中的应用方法。方法 实施气管、支气管异物取出术的小儿患者15例，ASAⅠ-Ⅱ,年龄2.5-11岁。在快速诱导麻醉下实施自制三通喉罩插入。插入成功后，三通喉罩一端口连接麻醉机进行机械控制通气，从另一带有密封胶帽端口置入支气管镜，经声门进入气管、支气管，实施异物取出术。术中监测收缩压(SBP)、舒张压(DBP)、心率(HR)、脉搏氧饱和度(SpO2)、潮气量(VT)、气道峰压(Ppeak)及呼气末二氧化碳分压(PETCO2)。记录麻醉、手术效果和过程。结果 全部15例手术顺利完成，SpO2在麻醉诱导开始后有明显改善，术中无明显下降；术中全部病例气道压力小幅升高，仍属于正常压力范围；手术时间8～36min，平均16min；麻醉时间39～60min，平均45min。术后恢复良好，无明显并发症。结论 自制三通喉罩用于小儿气管异物取出术具有安全、可靠、效果满意、并发症少等优点，在机器控制呼吸下实施手术，解决了既往手术和麻醉共用一个通道、呼吸管理困难的难题，取得了呼吸的控制权，保证了良好的通气和氧供，方便了手术操作，提高了麻醉安全性。 [关键词] 自制三通喉罩； 通气； 支气管镜； 小儿； 气管异物取出术 Application of three-way laryngeal mask airway ventilation in bronchial foreign bodies removal in children YANG Tian-ming1, HU Yun 1 ,CHEN Bo-chang1 ,QUAN Chao-kun2.(1 Department of Anesthesiology , 2 Department of Otolaryngology, 303rd Hospital of PLA, Nanning 530021，China) Abstract: Objective To investigate the clinical application of three-way laryngeal mask airway(TLMA) ventilation in rigid bronchoscope bronchial foreign bodies removal in children. Methods 15 patients aged from 2.5 to 11 yeas and admitted for tracheal intubation with TLMA ventilation under general anesthesia. SBP,DBP,HR,SPO2 ,VT, inspiratory airway pressure(Ppeak) and the expiratory co2 pressure(PETCO2)were monitored during the operation. Effect and time of operation and anesthesia were recorded. Results All the operations were successful, satisfactory effects were observed in all cases under study, No side effect and complications were observed in all cases. Conclusoin TLMA ventilation for tracheal foreign body removal with rigid bronchoscope in children is a simple, safe and economical method, adopting TLMA to management respiration in anesthesia taking out of the intratracheal foreign body in children would control respiration according to demand at any time. It may obtain the respiratory control power, guarantee the good ventilation and oxygen supply and improve