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| 间歇通气呼吸暂停在儿童喉乳头状瘤摘除术中的安全时限 |
| 宋娟,易寒,杨陶波,陈菲,刘巍,王寿勇* |
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(重庆医科大学附属儿童医院麻醉科, 国家儿童健康与疾病临床医学研究中心, 儿童发育疾病研究教育部重点实验室, 儿科学重庆市重点实验室, 重庆 401122
*通信作者) |
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| 摘要: |
| 目的 探讨间歇通气呼吸暂停麻醉法（AAIV）在小儿喉乳头状瘤摘除术中应用的安全时限。方法 回顾性分析我院2015－2019年诊断为喉乳头状瘤且术中实施AAIV患儿的麻醉记录，共计27例。从病历资料中提取患儿的性别、年龄、疾病诊断、体重、身高、血红蛋白水平、麻醉时间、手术时间、苏醒时间等数据建立理论计算模型，计算模型患儿实施AAIV期间耐受呼吸暂停和CO2蓄积的理论数值，并与现有文献报道进行比较。结果 麻醉和复苏期间未记录到严重缺氧、苏醒延迟等相关并发症，所有患儿围手术期生命体征平稳。经计算，模型患儿可耐受呼吸暂停时间为247～360 s（4.12～6.00 min），其间呼气末CO2分压（PETCO2）理论上可达74.26 mmHg（1 mmHg=0.133 kPa）。数据库检索文献报道呼吸暂停的时限平均值为224～292 s（3.73～4.87 min），平均动脉血CO2分压（PaCO2）或PETCO2位于70 mmHg以内。模型计算数据与现有文献报道的临床经验数据接近但不完全一致。结论 AAIV用于小儿喉乳头状瘤摘除术具有相应的理论支持依据，但在实际应用中，对于存在发育不良、呼吸道感染等影响通气储备功能的患儿，建议以脉搏血氧饱和度（SpO2）下降至95%为恢复通气的指征，同时应时刻警惕发生CO2蓄积。 |
| 关键词: 喉肿瘤 乳头状瘤 全身麻醉 通气 儿童 |
| DOI：10.16781/j.0258-879x.2021.09.1072 |
| 投稿时间：2020-06-22修订日期：2020-10-29 |
| 基金项目: |
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| Safe time limit of apneic anesthesia with intermittent ventilation for children receiving laryngeal papillomatosis resection |
| SONG Juan,YI Han,YANG Tao-bo,CHEN Fei,LIU Wei,WANG Shou-yong* |
(Department of Anesthesiology; National Clinical Research Center for Child Health and Disorders; Key Laboratory of Child Development and Disorders of Ministry of Education; Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing 401122, China
*Corresponding author) |
| Abstract: |
| Objective To explore the safe time limit of apneic anesthesia with intermittent ventilation (AAIV) for children receiving resection of laryngeal papillomatosis. Methods The anesthesia records of 27 children diagnosed with laryngeal papillomatosis and underwent surgery with AAIV in our hospital from 2015 to 2019 were analyzed retrospectively. The data of gender, age, disease diagnosis, body weight, height, hemoglobin level, anesthesia time, operation time, and recovery time were obtained from the medical records, and the theoretical calculation model was constructed to calculate the theoretical safe time limit and CO2 accumulation. The results were compared with the existing literatures. Results No serious complications such as severe hypoxia and delayed recovery were recorded during anesthesia and resuscitation, and the perioperative vital signs were stable in all patients. According to the calculation, the theoretical apnea time limit was 247-360 s (4.12-6.00 min) in the model patient, and the theoretical partial pressure of carbon dioxide at end-trial (PETCO2) reached 74.26 mmHg (1 mmHg=0.133 kPa). The average time limit of apnea in the retrieved literatures was 224-292 s (3.73-4.87 min), and the average arterial partial pressure of carbon dioxide (PaCO2) or PETCO2 was within 70 mmHg. The calculated data of the model were close to the clinical experience data reported in the existing literatures but not completely consistent. Conclusion AAIV for laryngeal papilloma removal in children has corresponding theoretical evidence. However, in practical applications, for children with dysplasia, respiratory tract infections or other diseases which can affect the lung reserve function, it is recommended to take reduction of pulse oxygen saturation (SpO2) to 95% as an indication to restore ventilation, and we always need to pay attention to CO2 accumulation. |
| Key words: laryngeal neoplasms papilloma general anesthesia ventilation children |
