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目的探讨小儿喉蹼患者的最佳麻醉管理。方法回顾性分析我院2009年12月至2013年3月经纤维喉镜、颈部X线或薄层CT确诊喉蹼的24例小儿患者的麻醉管理。结果所有患儿在术前均有不同程度的呼吸困难,手术的目的是解决通气问题。气管切开13例,其中6例术前先局麻下行气管切开后全麻,7例全麻插管后行气管切开;未行气管切开11例,直接在全麻下行气管内插管。诱导方式:快诱导经气管切口插管6例,快诱导经口插管7例,保留自主呼吸浅全麻诱导10例,1例先采用保留自主呼吸浅全麻诱导,第1次经口喉镜明视下插管失败后,面罩通气良好的情况下,改用快诱导,换管第3次插管成功。插管成功率:5例一次插管成功,10例两次插管成功,3例三次插管成功,平均插管时间12min。所有患儿均未出现诱导期缺氧,但有13例呼气末二氧化碳分压(PetCO2)明显偏高。所有患儿均安全完成麻醉诱导。结论术前充分的气道评估、完善的麻醉前准备及良好的团队协作是先天性喉蹼患儿围术期麻醉管理的关键。小儿喉蹼作为已预料的困难气道推荐选用保留自主呼吸浅全麻比较安全。
Objective To investigate the best anesthesia management in pediatric laryngeal webs. Methods A retrospective analysis of our hospital from December 2009 to March 2013 by fiber laryngoscope, neck X-ray or thin-layer CT confirmed throat web of 24 pediatric patients anesthesia management. Results All patients had varying degrees of dyspnea before surgery. The purpose of surgery was to solve the problem of ventilation. Tracheotomy in 13 cases, including 6 cases of preoperative local anesthesia tracheotomy general anesthesia, tracheotomy tube after tracheotomy in 7 cases; without tracheotomy in 11 cases, direct tracheal intubation under general anesthesia tube. Induction: fast induction of tracheal intubation in 6 cases, 7 cases of rapid induction of oral intubation, retained spontaneous breathing induction of general anesthesia in 10 cases, 1 case of spontaneous breathing with shallow general anesthesia induction, the first oral larynx Mirror under the tube fails, the mask is well ventilated, switch to fast induction, tube for the third intubation success. The success rate of intubation: 5 cases of a successful intubation, 10 cases of two successful intubation, three cases of successful intubation, the average intubation time 12min. No induction of hypoxia occurred in all children, but 13 patients had a significantly higher partial pressure of carbon dioxide (PetCO2). All children were safely anesthetized. Conclusion The adequate preoperative airway assessment, perfect preparation before anesthesia and good teamwork are the key to perioperative anesthesia management in children with congenital throat. Pediatric throat web as an expected difficult airway Recommended use of spontaneous breathing shallow general anesthesia safer.