先天性食道闭锁半气管食管漏手术的麻醉处理效果观察
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摘要
目的:对先天性食道闭锁伴气管食管瘘手术的麻醉处理效果进行观察。方法:选取我院收治的先天性食管闭锁伴气管食管瘘37例,其中21例手术选用气管插管控制呼吸为对照组(静脉注射,诱导丙泊酚1～2 mg/kg、阿曲库铵0.5 mg/kg、盐酸瑞芬太尼2μg/kg);16例行气管插管保留自主呼吸为观察组(氯胺酮1～2 mg/kg、丙泊酚1～2 mg/kg缓慢行静脉注射,气管插管保留自主呼吸,器官食管瘘管钳后静脉施以阿曲库铵0.5 mg/kg、盐酸瑞芬太尼2μg/kg,对呼吸进行控制)。结果:对照组21例患儿中,13例诱导时发生胃胀气,气道阻力呈现增加状态;单肺通气10 min,血氧饱和度(SpO_2)下降17例,对呼吸参数行适当调整,多次间隔双肺通气,确保SpO_2维系于95%之上,术后胸片显示肺炎加重4例;3例术后进入监护病房(NICU),行呼吸机维系,3 d后恢复正常呼吸;术后死亡7例。观察组16例患儿手术过程中生命体征平稳;单侧肺通气10 min,SpO_2下降3例,手控辅助呼吸后均在5 min内恢复;术后胸片显示,无明显肺炎加重;术后死亡1例。结论:先天性食道闭锁伴气管食管瘘手术行慢诱导气管内插管保留自主呼吸与气管食管瘘管钳闭后控制呼吸相结合的全身麻醉,可以对单肺通气时SpO_2下降行有效减少,减少术后并发症,提高患儿治疗安全性,降低生命危险。
Objective:To observe the anesthetic effect of congenital esophageal atresia with tracheoesophageal fistula. Methods: 37 patients with congenital esophageal atresia and tracheoesophageal fistula admitted to our hospital were enrolled in the hospital. Twenty-one patients underwent endotracheal intubation to control respiration as a control group(intravenous injection, propofol 1-2 mg/kg, atracurium 0.5 mg)./kg, remifentanil hydrochloride 2 μg/kg); 16 cases of patients underwent tracheal intubation retained spontaneous breathing were the observation group(ketamine 1 ～ 2 mg/kg, propofol 1 ～ 2 mg/kg slow intravenous injection, trachea and intubation retained spontaneous breathing, and the organ esophageal fistula was intravenously administered with atracurium 0.5 mg/kg and remifentanil hydrochloride 2 μg/kg to control the breathing).Results:Among the 21 patients in the control group, 13 patients developed bloating and airway resistance increased during induction. One-lung ventilated for 10 min, on blood oxygen saturation(SpO_2) 17 cases decreased, and the respiratory parameters were adjusted appropriately.Multiple intervals of double lung ventilation ensure that SpO_2 maintains above 95%, and postoperative chest radiograph shows 4 cases of pneumonia aggravated.Three patients entered the intensive care unit(NICU) after surgery, and the breathing machine was maintained the life. Normal breathing was restored after 3 days; 7 patients died after operation. The vital signs of the 16 patients in the observation group were stable during the operation; unilateral pulmonary ventilated for 10 min, 3 SpO_2 decreased, and recovered within 5 min after manual assisted respiration;postoperative chest radiograph showed no significant pneumonitis got aggravated; 1 patient died after surgery.Conclusion:Congenital esophageal atresia with tracheoesophageal fistula is a slow-inducing endotracheal intubation that preserves spontaneous anesthesia combined with tracheal esophageal fistula and controlled respiratory reflex,which can effectively reduce the decrease of SpO_2 in single lung ventilation, reduce postoperative complications, improve the safety of treatment of patients and reduce the risk of life.
Objective:To observe the anesthetic effect of congenital esophageal atresia with tracheoesophageal fistula. Methods: 37 patients with congenital esophageal atresia and tracheoesophageal fistula admitted to our hospital were enrolled in the hospital. Twenty-one patients underwent endotracheal intubation to control respiration as a control group(intravenous injection, propofol 1-2 mg/kg, atracurium 0.5 mg)./kg, remifentanil hydrochloride 2 μg/kg); 16 cases of patients underwent tracheal intubation retained spontaneous breathing were the observation group(ketamine 1 ～ 2 mg/kg, propofol 1 ～ 2 mg/kg slow intravenous injection, trachea and intubation retained spontaneous breathing, and the organ esophageal fistula was intravenously administered with atracurium 0.5 mg/kg and remifentanil hydrochloride 2 μg/kg to control the breathing).Results:Among the 21 patients in the control group, 13 patients developed bloating and airway resistance increased during induction. One-lung ventilated for 10 min, on blood oxygen saturation(SpO_2) 17 cases decreased, and the respiratory parameters were adjusted appropriately.Multiple intervals of double lung ventilation ensure that SpO_2 maintains above 95%, and postoperative chest radiograph shows 4 cases of pneumonia aggravated.Three patients entered the intensive care unit(NICU) after surgery, and the breathing machine was maintained the life. Normal breathing was restored after 3 days; 7 patients died after operation. The vital signs of the 16 patients in the observation group were stable during the operation; unilateral pulmonary ventilated for 10 min, 3 SpO_2 decreased, and recovered within 5 min after manual assisted respiration;postoperative chest radiograph showed no significant pneumonitis got aggravated; 1 patient died after surgery.Conclusion:Congenital esophageal atresia with tracheoesophageal fistula is a slow-inducing endotracheal intubation that preserves spontaneous anesthesia combined with tracheal esophageal fistula and controlled respiratory reflex,which can effectively reduce the decrease of SpO_2 in single lung ventilation, reduce postoperative complications, improve the safety of treatment of patients and reduce the risk of life.
引文
[1] 李海红,周京利,王汝敏,等.气管插管和喉罩用于全麻腹腔镜胆囊切除手术麻醉深度监测的研究[J].河北医药,2011,33(13):1973-1974.
[2] 侯秀玲.不同麻醉方法用于剖宫产手术临床分析[J].河北医药,2012,34(10):1540-1541.
[3] 张新建,盛莉.先天性食管闭锁并气管食管瘘手术的麻醉探讨[J].临床医学,2010,30(9):106-107.
[4] 李聚禧.两种麻醉方式在小儿短小腹腔镜手术中的临床应用比较[J].临床医学,2012,32(8):67-68.
[5] 邵雷朋,王献良,潘登.先天性食管闭锁的诊断与治疗[J].临床医学,2012,32(12):43-45.
[6] 章蔚,方才,谢言虎,等.神经刺激器辅助下腰丛联合坐骨神经阻滞与腰硬联合麻醉在膝关节镜手术麻醉的效果比较[J].安徽医学,2011,32(7):918-921.
[7] 文伟名.BIS监测下全身麻醉在宫颈癌患者手术中应用[J].安徽医学,2013,34(1):45-47.
[8] 陈宏福,张瑞东,高宝斌.全麻复合硬膜外麻醉在妇科腹腔镜手术中的效果及对血流动力学的影响[J].浙江医学,2016,38(16):1351-1353.
[2] 侯秀玲.不同麻醉方法用于剖宫产手术临床分析[J].河北医药,2012,34(10):1540-1541.
[3] 张新建,盛莉.先天性食管闭锁并气管食管瘘手术的麻醉探讨[J].临床医学,2010,30(9):106-107.
[4] 李聚禧.两种麻醉方式在小儿短小腹腔镜手术中的临床应用比较[J].临床医学,2012,32(8):67-68.
[5] 邵雷朋,王献良,潘登.先天性食管闭锁的诊断与治疗[J].临床医学,2012,32(12):43-45.
[6] 章蔚,方才,谢言虎,等.神经刺激器辅助下腰丛联合坐骨神经阻滞与腰硬联合麻醉在膝关节镜手术麻醉的效果比较[J].安徽医学,2011,32(7):918-921.
[7] 文伟名.BIS监测下全身麻醉在宫颈癌患者手术中应用[J].安徽医学,2013,34(1):45-47.
[8] 陈宏福,张瑞东,高宝斌.全麻复合硬膜外麻醉在妇科腹腔镜手术中的效果及对血流动力学的影响[J].浙江医学,2016,38(16):1351-1353.