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[1]宋兰娥,朱晓红.小儿复发性食管气管瘘胸腔镜修补术的气道管理[J].临床小儿外科杂志,2022,21(02):170-173.[doi:10.3760/cma.j.cn.101785-202011036-013]
　Song Lane,Zhu Xiaohong.Airway management of thoracoscopic surgery for recurrent tracheoesophageal fistula in children[J].Journal of Clinical Pediatric Surgery,2022,21(02):170-173.[doi:10.3760/cma.j.cn.101785-202011036-013]

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小儿复发性食管气管瘘胸腔镜修补术的气道管理

《临床小儿外科杂志》[ISSN:1671-6353/CN:43-1380/R] 卷: 第21卷期数: 2022年02期页码: 170-173 栏目: 论著出版日期: 2022-02-28

Title:: Airway management of thoracoscopic surgery for recurrent tracheoesophageal fistula in children

作者:: 宋兰娥; 朱晓红; 国家儿童医学中心首都医科大学附属北京儿童医院麻醉科, 北京 100045

Author(s):: Song Lan’e; Zhu Xiaohong; Department of Anesthesiology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing 100045, China

关键词:: 食管闭锁/并发症; 复发性食管气管瘘; 胸腔镜检查; 单肺通气

Keywords:: Esophageal Atresia/CO; Recurrent Esophagotracheal Fistula; Thoracoscopy; One-lung Ventilation

DOI:: 10.3760/cma.j.cn.101785-202011036-013

摘要:: 目的探讨小儿食管闭锁手术后复发性食管气管瘘胸腔镜修补术的气道管理策略。方法回顾性分析首都医科大学附属北京儿童医院29例复发性食管气管瘘胸腔镜修补术患儿临床资料，收集术前情况、单肺通气方法、术中所见瘘口位置与瘘管外径等数据，观察单肺通气前（T1）、单肺通气后10 min（T2）、单肺通气后30 min（T3）、单肺通气后60 min（T4）、单肺通气结束（T5）、手术结束（T6）6个时点PETCO₂和SpO₂的变化。结果患儿术前均存在不同程度肺炎。6个时点PETCO₂随单肺通气时间的延长而逐渐升高，单肺通气结束后回落（P=0.001）。术中出现低氧血症3例，最低SpO₂分别为85%、86%和87%。6个时点SpO₂差异无统计学意义（P>0.05）。结论对于复发性食管气管瘘的胸腔镜修补术，避免瘘口通气和加强气道管理是麻醉管理的重点，但尽快手术结扎瘘管仍是关键。对于位置较高的瘘口，CO₂人工气胸、支气管阻塞器和支气管插管3种单肺通气方法均可行。对于隆突附近的瘘口，若瘘口较小，3种方法均可行；若瘘口较大，最好选择左主支气管插管法。

Abstract:: Objective To explore the anesthetic airway management for thoracoscopic surgery (TS) of recurrent tracheoesophageal fistula (rTEF).Methods A retrospective analysis was conducted on the clinical data of 29 patients of rTEF undergoing thoracoscopic repair.Information on preoperative conditions, one-lung ventilation methods, and location and size of the fistula were collected.Changes of PETCO₂ and SpO₂ at 6 time points (before one-lung ventilation, one-lung ventilation for 10 minutes, 30 minutes, 60 minutes, the end of one-lung ventilation, and the end of operation) were observed.Results Varying degrees of pneumonia were found in all children before the operation.PETCO₂ gradually increased with the prolonged one-lung ventilation, and then dropped after the end of one-lung ventilation (P=0.001).SpO₂ dropped to below 90% in 3 children, with the lowest reaching 85%, 86%, and 87% respectively.There was no statistically significant difference in SpO₂ at 6 time points (P>0.05).Conclusion For TS of rTEF the focus of anesthesia management is to avoid fistula ventilation and strengthen airway management.However, to ligate the fistula as soon as possible remains the top priority.For high fistulas and small fistula near the carina, it is feasible to adopt.one-lung ventilation methods of CO₂ artificial pneumothorax, bronchial obstructor and bronchial intubation Yet for big fistula near the carina, it is best to choose the left main bronchus intubation method.

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备注/Memo

收稿日期:2021-09-14。
通讯作者:朱晓红,Email:zxh_1006@126.com

更新日期/Last Update: 1900-01-01