摘要
目的探讨恶性气道狭窄患者经硬质气管镜硅酮支架置入术的麻醉管理措施。方法选取该院2019年3月至2020年6月接受硬支气管镜硅酮支架置入术的患者32例,麻醉过程分为软镜期、硬镜期和恢复期3个阶段。软镜期在镇静镇痛保留自主呼吸的条件下对气道进行预处理;硬镜期在软镜期镇静镇痛的基础上适当加深麻醉、完善肌松,采用窒息氧合联合呼吸机半密闭式通气技术维持氧合,全程严密监测二氧化碳或动脉血气;恢复期置入喉罩间歇正压通气常规麻醉复苏。结果软镜期均无呼吸抑制或呼吸暂停和严重呛咳发生;硬镜期间发生低氧血症2例,心律失常2例;恢复期31例患者在手术间拔除喉罩,1例患者因肺功能差需机械通气而插入气管导管。所有患者软镜期、硬镜期、恢复期均无经皮血氧饱和度(SpO_(2))下降,且均高于麻醉诱导前(P<0.05);硬镜置入时平均动脉压(MAP)、心率(HR)均较其他时间点升高;支架置入时潮气末二氧化碳(P_(ET)CO_(2))明显高于其他时间点(P<0.05)。结论恶性气道狭窄患者行硬质气管镜硅酮支架置入术时可考虑实施分阶段麻醉。
Objective To investigate the anesthetic management measures of rigid bronchoscopy with silicone stent placement in the patients with malignant airway stenosis.Methods A total of 32 patients who underwent rigid bronchoscopy with silicone stent placement in this hospital from March 2019 to June 2020 were selected.The anesthesia process was divided into three stages:flexible endoscopy,rigid endoscopy and recovery.In the flexible endoscopy period,the airway was pretreated under sedation and analgesia while preserving spontaneous breathing;in the rigid endoscopy period,based on the sedation and analgesia in the flexible endoscopy period,the anesthesia was appropriately deepened and the muscle relaxation was perfected,the oxygenation was maintained by using apnea oxygenation combined with breathing machine semi-closed ventilation technology,and carbon dioxide or arterial blood gas was closely monitored throughout the process;during the recovery period,a laryngeal mask was placed in intermittent positive pressure ventilation for routine anesthesia resuscitation.Results There was no respiratory depression or apnea and severe coughing during the flexible endoscopy period;two cases of hypoxemia and two cases of arrhythmia occurred during the rigid endoscopy period.During the recovery period,the laryngeal masks were removed in the operating room in 31 cases,and a tracheal tube was inserted in one case requiring mechanical ventilation due to poor pulmonary function.There was no transcutaneous oxygen saturation(SPO_(2))decrease in all patients during the flexible endoscopic period,rigid endoscopic period and recovery period,moreover,the SPO_(2) of these patients during anesthesia was higher than that before anesthesia induction(P<0.05).The mean arterial pressure(MAP)and heart rate(HR)during the rigid endoscopic placement were higher than those at other time points.The end-tidal carbon dioxide(P_(ET)CO_(2))at stent placement was significantly higher than that at other time points(P<0.05).Conclusion Staged anesthesia may be con
作者
方亮
谭宇亭
黄赞胜
张皓琳
李洪
FANG Liang;TAN Yuting;HUANG Zansheng;ZHANG Haolin;LI Hong(Department of Anesthesiology,Second Affiliated Hospital of Army Medical University,Chongqing 400037,China;Department of Respiratory,Second Affiliated Hospital of Army Medical University,Chongqing 400037,China)
出处
《重庆医学》
CAS
2022年第19期3322-3326,共5页
Chongqing medicine
关键词
恶性气道狭窄
硬质气管镜
硅酮支架
麻醉
malignant airway stenosis
rigid tracheoscopy
silicone stent
anesthesia
