Huang Weijian,Li Yongle,Chen Peiling,et al.Application of laryngeal mask airway with spontaneous breathing under general anesthesia during holmium laser ablation for infantile subglottic stenosis[J].Journal of Clinical Pediatric Surgery,2019,18(04):319-322.[doi:10.3969/j.issn.1671-6353.2019.04.014]
保留自主呼吸喉罩全麻在婴儿声门下狭窄钬激光消融术中的应用
- Title:
- Application of laryngeal mask airway with spontaneous breathing under general anesthesia during holmium laser ablation for infantile subglottic stenosis
- Keywords:
- Glottis; Tracheal Stenosis; Catheter Ablation; Laser Therapy; Low-Level; Infant
- 分类号:
- R729;R614.2;R767.4+4
- 摘要:
- 目的 评价保留自主呼吸喉罩全麻在婴儿声门下狭窄钬激光消融术中的可行性和安全性。方法 选取2017年1月至2017年12月由广东省妇幼保健院行钬激光消融术治疗的声门下狭窄患儿8例，所有患儿采用喉罩置入下全身麻醉，保留自主呼吸，收集患儿的一般资料、狭窄原因、手术时长、麻醉操作时间，记录术中血氧饱和度的变化，术中并发症的发生和处理方法。结果 所有患儿顺利完成手术。8例均为获得性狭窄，狭窄部位均<2.8 mm，其中1例狭窄部位为1 mm。手术时间平均为（50±5.81）min，麻醉诱导时间为（10.62±1.49）min，血氧饱和度下降需停止手术加压给氧均集中在烧灼的前2次。术中除了出现血氧饱和度下降外，还出现了气管痉挛、声门活动度过大、分泌物增多等不良事件。结论 喉罩置入能安全用于婴儿声门下狭窄的治疗，良好的气道表面麻醉和保留自主呼吸，能给予术者充分的手术操作时间，减少手术的耗时，降低麻醉的风险，值得在临床上推广。
- Abstract:
- Objective To explore the feasibility and safety of laryngeal mask airway (LMA) with spontaneous breathing under general anesthesia during holmium laser ablation for infants with subglottic stenosis.Methods Eight infants with acquired subglottic stenosis undergoing holmium laser ablation from January 2017 to December 2017 were enrolled.All of them received general anesthesia with spontaneous breathing using LMA.Patient characteristics,cause of subglottic stenosis,operative duration,induction time,SpO2 changes,complications and managements were recorded.Results All children were operated successfully.And all stenoses were less than 2.8mm and the narrowest one 1 mm.The mean operation duration was (50±5.81) min while induction time (10.62±1.49) min.Oxygen desaturation occurred mostly during the first two ablation attempts when operations ceased and assisted ventilation was supplied.Other adverse events included airway spasm,vocal cord overmoving and airway hypersecretion.Conclusion LMA insertion is safe and effective for infantile subglottic stenosis.Sufficient airway surface anesthesia with spontaneous breathing allow surgeons to gain more operation time.And it can reduce operative duration and anesthetic risk.Wider clinical promotion is recommended.
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[2]刘 鹏 张建良 刘建滨 钟礼立 周文武.多排螺旋ＣＴ气道、血管三维重建评估先天性左肺动脉吊带患儿气道狭窄的作用探讨[J].临床小儿外科杂志,2018,17(01):47.
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备注/Memo
收稿日期:2018-08-25。
通讯作者:胡祖荣,Email:hzrong136@163.com