| 摘要: |
| 目的 探讨经支气管镜硅酮支架置入术的麻醉管理措施。方法 收集行支气管镜下硅酮支架置入术的患者10例，将麻醉过程分为软质支气管镜期（软镜期）、硬质支气管镜期（硬镜期）和复苏期3个阶段。采用咪达唑仑1~2mg、丙泊酚1.5~2.5mg/kg或依托咪酯0.15~0.3mg/kg、舒芬太尼10~15μg快速静脉诱导，丙泊酚30~167μg/（kg·min）和瑞芬太尼0.03~0.2μg/（kg·min）术中静脉泵注维持。软镜期先进行软镜下气道预处理，自主呼吸或行间歇指令正压通气。硬镜期肌松完善后硬镜下置入硅酮支架，采用高频血喷射通气，间歇监测呼气末二氧化碳分压（PETCO2）。术毕复苏期继续间歇指令正压通气。全程监测心电图、血压和脉搏血氧饱和度（SpO2）。软镜期和复苏期连续监测PETCO2，硬镜期间歇监测PETCO2。结果10例患者围术期循环稳定，血压、心率均在正常范围，SpO2均能维持正常水平，硬镜操作结束时的PETCO2明显高于麻醉诱导前、软镜结束时和拔管时（P＜0.01）。结论支气管镜下硅酮支架置入术采取分阶段的麻醉管理简单安全可行。 |
| 关键词: 高频喷射通气 硬质支气管镜 硅酮支架 |
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| Staged anesthetic management for insertion of silicone stent under bronchoscopy |
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CHEN Limei, LIU Fuli, LIU Le, DONG Dongmei, XU Xunzhong
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the First Affiliated Hospital of Wenzhou Medical University
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| Abstract: |
| Objective To assess the staged management of anesthesia for insertion of silicone stent under bron
choscopy. Methods The anesthesia records of 10 cases of operation with insertion of silicone stent under bronchoscopy were retrospectively reviewed. By using intravenous fast induction, 1~2mg midazolam, 1.5~2.5mg/kg propofol or 0.15~0.3mg/kg etomidate, 10~15μg sufentanyl were injected successively. During the operationa total intravenous anesthesia(TIVA) was maintained by propofol 30~167μg/(kg·min) and remifentanyl 0.03~0.2μg/(kg·min). First interventional pulmonary procedures were under fiexible bronchofiberscope(FB) with spontaneous ventilation or Intermittent Positive-Pressure Ventilation (IPPV). Then a rigid bronchoscope (RB) was inserted into the trachea to insert the silicone stent by High-Frequency Jet Ventilation (HFJV). IPPV was used again after operation. The whole process of anesthesia can be divided into three stages, FB operation, RB operation and recovery. The end-tidal carbon dioxide tension(PETCO2), blood pressures, heart rates and SpO2 were monitored. Results PETCO2 in the end of RB operation was higher than the other time points (P＜0.01). All the patients presented normal blood pressures, heart rates and SpO2.Conclusion During inserting the silicone stent under bronchoscopy, staged anesthetic management is safe and reliable. |
| Key words: High-Frequency Jet Ventilation(HFJV) Rigid bronchoscopy Silicone stent |
