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【关键词】高频
摘要：目的：观察静脉复合全麻下高频喷射通气（HFJV）在小儿气道异物取出术的临床效果。方法：患儿在进入手术室前肌注氯胺酮4～8mg/kg，待患儿安静入睡后进手术室，开通静脉通道后缓慢注射羟丁酸钠（r-OH）80～100 mg/kg，约10min后以1%地卡因作喉部表面雾化喷入，较大患儿于环甲膜穿刺注入1%地卡因1ml，5min后即可手术，手术时间超过90min者，可追加氯胺酮、r-OH等。术中HFJV采用国产KR-Ⅱ呼吸机，电控气动进行喷射通气，频率根据缺氧程度选用144～200次/min，气源驱动压0.6～1.2 kg/cm2。结果：术中麻醉平稳、缺O2改善，52例气管、支气管异物的患儿在静脉复合全麻下行高频喷射通气均顺利完成手术。结论：静脉复合全麻下行HFJV在小儿气道异物取出术的应用效果是确切的。
关键词：高频喷射通气；小儿；气管异物取出
The Application of General Anesthesia High-frequency Jet Ventilation in the Infantile Air Passage Foreign Body Extraction
Abstract： Objective: To observe the clinical effect of the HFJV under general intravenous combined anesthesia in the infantile air passage foreign body extraction. Method: Before entering the operating room, the infant patient was injected with ketamine of 4～8 mg/kg. Then the sleeping infant patient was sent to the operating room, and the r-OH of 80～100 mg/kg was slowly injected after the intravenous trackwas ready there. 10 minutes later, the 1% dicaine was sprayed nebulizationally via the throat, and for the bigger infant, 1% dicaine of 1 ml was injected by intercricocentesis. And the operation was conducted 5 minutes later. For the patients whose operation time exceeded 90 minutes, the ketamine and r-OH would have been added for the second time. During the operation, the domestic KR-II respirator and electric-control pneumatic method were used for jet ventilation with the frequency of 144～200 times/a minute chosen upon the oxygen lack level and the a无忧论文 【http://www.uklunwen.com】ir source driving pressure being 0.6～1.2 kg/cm2.Result: During the operation, the anesthesia was stable and the oxygen lack level had been improved. The 52 cases of operation of infants with foreign bodies in trachea or bronchus were completed smoothly by the HFJV under the complete intravenous combined anesthesia.Conclusion: The application of complete intravenous combined anesthesia HFJV is effective in the infantile air passage foreign body extraction.
Key words: High-frequency jet ventilation；Infant；Air passage foreign body extraction
我院自2001年1月至2004年6月，在全麻下采用国产KR-Ⅱ型高频喷射通气（HFJV）呼吸机在52例小儿气管、支气管异物取出术中的应用，取得较好的临床效果，现报告如下：
1 资料与方法
1.1 临床资料：本组52例，男32例，女20例。气管异物15例，支气管异物37例。年龄9个月至1岁10例，1岁以上至2岁25例，2岁以上至5岁13例，9岁2例。中度缺O214例，严重缺O238例。手术时间最短为15min，最长为120min。
1.2 麻醉方法：术前30min肌注阿托品0.01～0.02mg/kg。一般情况较好的患儿用复方冬眠灵1.0～1.5mg/kg肌注，对不合作小儿按4～8 mg/kg予氯胺酮肌注。待神志消失，以80～100 mg/kg静脉缓慢推注r-OH。下颌肌松驰后用喉镜撑开下颌，以1%地卡因予喉部表面雾化喷入，较大儿童加环甲膜穿刺注入1%地卡因1ml，5min后即可手术。若手术时间超过90min后，予追加氯胺酮2～4mg/kg肌注，r-OH 25～35mg/kg静注。
1.3 高频通气装置与方法：HDJV采用国产KR-Ⅱ型呼吸机，将16号喷射针头固定在平支气管镜近端开口旁开1.5cm针座处，连接氧气瓶，电控气动进行喷射通气。通气频率，中度缺氧144次/min，重度缺氧200次/min。气源驱动压0.6～1.2kg/cm2。
2 结果
本组52例气管、支气管异物，在全麻下用HFJV均能在不同时间内取出，见表1。
表1 不同缺O2程度气管、支气管异物取出时间 略
由表1可见，本组病例中有1例手术时间长达120min，该例为1.5岁幼儿支气管花生米异物患者，发病时间长，并发肺部感染，异物吸收水份后而膨胀，在夹取时易碎，需反复多次夹取，这是手术时间延长原因之一。另外，由于其术前有肺炎，肺不张等并发症引起呼吸功能紊乱，加之手术时间延长后麻醉变浅，以及手术刺激出现憋气，加重机体缺氧，故不时中止手术，除了加深麻醉深度外，还予增加频率，人工 |
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