摘要
目的探讨儿童喉乳头状瘤伴呼吸困难病例更加安全可行的全麻诱导方式。方法选择喉阻塞II度的喉乳头状瘤患儿50例,随机分为七氟烷吸入诱导组(吸入组)与氯胺酮-咪唑安定静脉诱导组(静脉组),每组25例。分别记录诱导前、插管后1分钟血压、心率及脉搏血氧饱和度(saturated pulse oxygen,SpO2)变化并进行气管插管条件评分。结果①吸入组气管插管条件满意者16例,一般者7例,差者2例;静脉组气管插管条件满意者6例,一般者13例,差者6例,插管满意率吸入组明显高于静脉组,P<0.05。②两组气管插管前血压、心率及SpO2无明显差异,P>0.05。③插管完成后即刻静脉组血压和心率明显高于吸入组[(68.7±6.4)mmHgvs.(64.0±8.0)mmHg;(142.6±13.8)bpmvs.(124.6±12.5)bpm;P<0.05];插管完成后即刻静脉组血压和心率明显高于插管前[(68.7±6.4)mmHgvs.(63.6±5.8)mmHg;(142.6±13.8)mmHgvs.(121.2±11.7)bpm;P<0.05];吸入组血压和心率与插管前对比无显著差异[(64.0±8.0)mmHgvs.(61.8±7.7)mmHg;(124.6±12.5)bpmvs.(118.2±11.3)bpm;P>0.05]。④静脉组3例插管后呛咳剧烈,SpO2低于93%;吸入组插管后未出现剧烈呛咳及SpO2下降。两组SpO2下降率存在明显差异,P<0.05。结论七氟烷吸入诱导法,无需肌肉松弛剂即可提供良好的气管插管条件,用于存在呼吸困难的喉乳头状瘤患儿安全可行。与氯胺酮、咪唑安定静脉诱导相比,更利于保持循环稳定,减少插管后低氧血症发生。
OBJECTIVE To find the safer anesthesia induction methods in children with laryngeal papilloma combined by dyspnea. METHODS 50 laryngeal papilloma children with Ⅱ degree laryngeal obstruction were randomly divided into 2 groups： inhalational group and intravenous group, no muscle relaxant was used in either of the groups. MAP, and SpO2 were observed at one minute before and after induction. The intubation condition was also assessed and compared between the 2 groups. RESULTS MAP and HR in intravenous group were significantly higher than those of inhaled group after intubation [ （68.7±6.4） mmHg vs. （64.0±8.0） mmHg; （142.6± 13.8） bpm vs. （124.6±12.5） bpm; P〈0.05]; Tracheal intubation caused significant increase of MAP and HR in intravenous group [ （68.7±6.4）mmHg vs. （63.6± 5.8） mmHg; （142.6±3.8） bpm vs. （121.2±11.7） bpm; P〈0.05]. There wasn＇t significant difference of MAP and HR before and after intubation in the inhaled group[ （64.0±8.0） mmHg vs. （61.8±7.7） mmHg; （124.6±12.5） bpm vs. （118.2±11.3） bpm; P〉0.05]. For the intubation condition, the satisfactory rate in inhaled group was higher than that of intravenous group, P〈0.05. All patients, except 1 in intravenous group, were successfully intubated at the first attempt. 3 patients in intravenous group experienced transient hypoxia caused by severe cough （SpO2 less than 93%） but no such cases in inhaled group. There was significant difference of SpO2 between the two groups. CONCLUSION Without muscle relaxant, sevoflurane inhalation can facilitate tracheal intubation more smoothly. Compared with ketamine and midazolam intravenous injection, sevoflurane induction is safer in severe laryngeal papilloma ectomy combined with dyspnea in children.
出处
《中国耳鼻咽喉头颈外科》
北大核心
2009年第4期215-217,共3页
Chinese Archives of Otolaryngology-Head and Neck Surgery
关键词
乳头状瘤
呼吸困难
儿童
麻醉药
吸入
插管法
气管内
Papilloma
Dyspnea
Child
Anesthetics, Inhalation
Intubation, Intratracheal
