摘要
目的分析小儿全麻复苏期呼吸抑制的原因并提出护理对策。方法回顾性分析2017年3月至2018年9月在我院小儿外科、耳鼻喉科接受全身麻醉且术后进入麻醉复苏室的小儿共1102例,按照是否在清醒状态下拔管分为唤醒后拔管组和镇静下拔管组,观察两组患儿的收缩压(SBP)、心率(HR)、脉氧饱和度(SPO2)、唇绀例数、呛咳憋气例数、哭闹例数;拔管后记录是否出现舌后坠、支气管痉挛、喉痉挛、喉头水肿等情况。结果 1102例住院手术患儿中术前哭闹致分泌物增加,插管时需先负压吸引后再插管者25例(2. 27%),经历反复插管的患儿15例(1. 36%),插管时管径或套囊稍大,过气道最狭窄处困难但稍使力能通过者18例(1. 63%)。气道不良反应的发生情况:拔管过早导致肌松残余,胸廓动度欠佳,潮气量及呼吸频率不足而致呼吸抑制需面罩辅助呼吸者有10例(0. 91%);舌根后坠有鼾声需辅助抬起下颌者90例(8. 17%);支气管痉挛,肺部听诊有哮鸣音者28例(2. 54%);喉头水肿需追加地塞米松及高浓度面罩吸氧者5例(0. 45%);喉痉挛需面罩给予高浓度氧气者3例(0. 27%)。经及时相应处理后,均无严重缺氧发生,患儿无后遗反应。唤醒后拔管组的SBP明显比镇静下拔管组高、HR更快、SPO2更低,发生唇绀例数、呛咳憋气例数、哭闹例数更多,差异有统计学意义(P<0. 05)。结论在围麻醉期均应准备好麻醉用物、氧源、抢救药品,尤其要重视加强患儿麻醉苏醒期呼吸道管理及护理,一旦发生呼吸抑制,应立即予相应处理,保证有效通气,保障患儿生命安全。
Objective To analyze the causes of respiratory depression during the recovery period of pediatric general anesthesia and put forward nursing countermeasures.Methods A retrospective analysis was performed on 1,102 children who received general anesthesia in the department of pediatric surgery and otolaryngology of our hospital from March 2017 to September 2018. The children entered the post anesthesia care unite(PACU) after the surgery.The children were divided into extubation group after awakening and extubation group under sedation according to whether or not they were extubation under awake state.The systolic blood pressure(SBP),heart rate(HR),pulse oxygen saturation( SPO2),and number of cyanosis,choking and or crying of the two groups were observed.After extubation,the numbers of tongue drop,bronchospasm,laryngeal spasm,and laryngeal edema were recorded. Results Among the 1,102 hospitalized children undergoing surgery,25 cases(2. 27%) needed negative pressure suction before intubation because their secretions were increased due to crying before surgery. There were 15 cases(1. 36%) experiencing repeated intubation.There were 18 cases(1. 63%) with difficulty in passing through the narrowest part of the airway due to a slightly larger tube diameter or thimble.There were 10 cases(0. 91%) with adverse airway reactions such as residual muscle relaxation due to premature extubation,poor thoracic mobility,insufficient tidal volume and respiratory frequency,and respiratory depression caused by mask-assisted breathing.There were 90 cases(8. 17%) needing assistance to lift their mandible.Bronchospasm and lung auscultation with asthma were found in28 cases(2. 54%).There were 5 cases(0. 45%) with laryngeal edema requiring supplemental dexamethasone and mask administration of high oxygen concentration.There were three cases(0. 27%) of laryngeal spasm requiring mask administration of high oxygen concentration.After timely and appropriate treatment,no severe hypoxia occurred,and the children had no residual effect.After awake
作者
曾薇
陈旭
潘先凤
伍励
ZENG Wei;CHEN Xu;PAN Xian-feng;WU Li(Department of Anesthesia,Sichuan Maternal and Children Health Care Hospital,Chengdu 610045 China)
出处
《实用医院临床杂志》
2019年第4期224-227,共4页
Practical Journal of Clinical Medicine
关键词
呼吸抑制
小儿
全麻
护理
Respiratory depression
Pediatrics
General anesthesia
Nursing
