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目的探讨慢诱导技术并高频喷射通气(HFJV)在婴幼儿气管异物取出术的效果及安全性。方法 40例行气管异物取出术的患儿完全随机分为咽喉表面醉慢诱导气管内插管组(E组)和对照组(F组),每组20例。E组静脉注射咪唑安定、芬太尼,4%利多卡因表面麻醉,1%丁卡因气管内麻醉后插入支气管镜后经侧孔HFJV;F组静脉注射氯胺酮、丙泊酚复合麻醉,保留自主呼吸,插入支气管镜后经侧孔HFJV。术中连续监测心电图、心率、呼吸和脉搏血氧饱和度(SpO2),比较两组患儿术中各生命体征变化及发生呛咳、屏气、呼吸暂停、支气管痉挛的次数。记录手术时间、苏醒时间及苏醒期并发症。结果 F组发生舌后坠3例,呛咳屏气11例,喉支气管痉挛3例。E组发生舌后坠1例,呛咳屏气2例,喉支气管痉挛0例。结论慢诱导技术HFJV在小儿气管异物取出术麻醉中的应用更为安全,可有效抑制应激反应,减少呛咳、屏气、呼吸暂停、支气管痉挛的发生,使手术过程更加顺利。
Objective To investigate the effect and safety of slow induction and high frequency jet ventilation (HFJV) in the removal of tracheal foreign bodies in infants. Methods Forty children with tracheal foreign body removal were randomly divided into two groups: group E (E) and control group (Group F), with 20 cases in each group. Group E received intravenous midazolam, fentanyl, 4% lidocaine topical anesthesia, endotracheal tube HFJV after 1% tetracaine intratracheal intubation, and group F ketamine and propofol anesthesia after intravenous injection Spontaneous breathing, insert bronchoscopy through the side hole HFJV. The electrocardiogram, heart rate, respiration and pulse oxygen saturation (SpO2) were continuously monitored during surgery. The changes of vital signs and the number of choking, breath holding, apnea and bronchospasm were compared between the two groups. Record operation time, recovery time and recovery period complications. Results There were 3 cases of tongue falling in Group F, 11 cases of cough and breath holding and 3 cases of laryngeal bronchial spasm. E group occurred after the fall of the tongue in one case, cough and breath in 2 cases, 0 cases of laryngeal bronchial spasm. Conclusion Slow induction of HFJV in tracheal foreign body removal anesthesia safer application, which can effectively inhibit the stress response and reduce the occurrence of choking, breath holding, apnea, bronchospasm, the operation process more smoothly.