国际麻醉学与复苏杂志   2010, Issue (1): 10-13
    
支撑喉镜下CO2激光治疗声门下息肉的麻醉管理
赵宏飞 刘金锋 岳云 周华成 方先海1()
1.哈尔滨医科大学附属二院麻醉科
Anesthetic management for CO2 laser treatment of polyp below glottis under self-retaining laryngoscope
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摘要:

目的 探讨非气管插管高频喷射通气(High- Frequency Jet Ventilation,HFJV)全凭静脉麻醉方法应用于声门下息肉激光切除的可行性。方法 42例ASAⅠ级~Ⅱ级声门下息肉手术患者,采用瑞芬太尼复合丙泊酚全凭静脉麻醉。在置入支撑喉镜前气管插管,机械控制通气,置入支撑喉镜即刻拔除气管插管,应用内径2.5 mm,外径3.0 mm的金属导管于声门下5 cm 处HFJV。术中持续监测并记录诱导前、气管插管机械控制通气后5 min、置入支撑喉镜即刻、HFJV 后1 min、HFJV 后5 min、 HFJV 后10 min、HFJV 后15 min 的心率(HR)、平均动脉压(MAP)、心电图(ECG)和脉搏氧饱和度(SpO2);在置入支撑喉镜拔除气管插管即刻和HFJV 后15 min 采集足背动脉血进行血气分析。记录术毕患者苏醒情况、麻醉时间和手术时间。结果 麻醉时间(30.1±3.8)min,手术时间(7.9±2.6)min,术中各时间点HR、 MAP 与支撑喉镜置入即刻相比差异有统计学意义(P<0.01),但与诱导前相比差异无统计学意义(P>0.05);术中所有患者保持SpO2≥99%;HFJV 后15 minPaCO2较拔除气管插管即刻升高,差异有统计学意义(P<0.01),但均低于70 mm Hg。结论 非气管插管HFJV 全凭静脉麻醉可安全用于声门下息肉激光切除。

关键词: 高频喷射通气;麻醉, 静脉;声门;息肉;激光治疗
Abstract:

Objective To investigate the application of intravenous anesthesia and high frequency jet ventilation(HFJV)without intubation for ectomy of polyp below glottis with laser. Methods 42 patients(ASAⅠ-Ⅱ)preparing for ectomy of polyp below glottis with laser were anesthetized intravenously with remifentenal and propofol. The patients were intubated and mechanical ventilated, and then extubated immediately after suspension laryngoscope insertion. A slender metal tube(ID2.5 mm, OD3.0 mm)which top was set 5 cm below glottis was used for airway management with HFJV. The heart rate(HR), mean arterial pressure(MAP), electrocardiogram(ECG)and pulse oxygen saturation(SpO2)were continuously monitored before induction, immediately after intubation and mechanical ventilation 5 min, immediately and after suspension laryngoscope insertion, after HFJV 1 min, 5 min, 10 min and 15 min. Blood gas analysis was carried out from the dorsal artery of foot at the point of immediately after suspension laryngoscope insertion and 15 min after HFJV. Analepsia time, anesthesia time, and the operation time were recorded. Results The anesthesia time was (30.1±3.8)min and the operation time was(7.9±2.6)min. The SpO2≥99% for all patients. The HR and the MAP were significant differences(P<0.01)compared with the point of immediately after suspension laryngoscope insertion, but no significant differences (P>0.05) compared with the point of before induction. The PaCO2 at the point of 15 min after HFJV was increased compared with extubation(P<0.01), but lower than 70 mm Hg. Conclusion Intravenous anesthesia and HFJV without intubation is safe for the ectomy of polyp below glottis with laser.

Key words: High-frequency jet ventilation; Anesthesia, Intravenous; Glottis; Polyps; Laser therapy