| 摘要: |
| 目的：观察麻醉预处理对存在气道高反应性的支气管肺泡灌洗患儿围术期呼吸系统不良事件的干预结果。方法：随机选取湖北医药学院附属太和医院小儿外科手术中心2018年1月至2019年6月接受喉罩全身麻醉行支气管肺泡灌洗的患儿82例，采用随机数表法分为对照组和实验组各41例。对照组给予我科小儿麻醉静脉快速诱导方案（使用药物依次为盐酸戊乙奎醚0.01 mg/kg、地塞米松0.1 mg/kg、得普利麻3 mg/kg、顺式阿曲库铵0.1 mg/kg、芬太尼4 μg/kg），置入喉罩静吸复合全身麻醉维持，实验组在常规诱导方案之前，静脉使用利多卡因1 mg/kg与二羟丙茶碱2 mg/kg，比较两组患儿术中不同时间点血流动力学指标、气道压以及围术期呼吸系统不良事件发生率。结果：对照组与实验组患儿不同时间点心率比较差异无统计学意义（P>0.05），仅在喉罩拔除时平均动脉压比较差异有统计学意义(P<0.05)，其他时间点平均动脉压比较差异无统计学意义（P>0.05）；实验组患儿进行肺泡灌洗时的气道压低于对照组(P<0.05)。实验组术中出现哮鸣音、血氧饱和度（SpO2）<90%、术中呛咳屏气等呼吸系统不良事件的的发生率为12.2%，明显低于对照组的31.7%（P<0.05）。结论：通过麻醉前利多卡因及二羟丙茶碱预处理，结合其他气道保护措施，对患儿围术期血流动力学变化影响不大，可降低术中气道压，减少呼吸系统不良事件发生率，保障患儿安全。 |
| 关键词: 气道高反应性 预处理 肺泡灌洗 全身麻醉 |
| DOI：doi:10.13407/ j.cnki.jpp.1672.108X.2021.09.006 |
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| 基金项目: |
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| Effects of Anesthesia Preconditioning on Perioperative Respiratory Adverse Events in Children Undergoing Bronchoalveolar Lavage |
| Zeng Wenjing, Luo Xianghong |
| (Taihe Hospital, Hubei University of Medicine, Hubei Shiyan 442000, China) |
| Abstract: |
| Objective: To observe the intervention effects of anesthesia preconditioning on perioperative respiratory adverse events in children with bronchial hyperresponsiveness undergoing bronchoalveolar lavage. Methods: A total of 82 children undergoing bronchoalveolar lavage with laryngeal mask general anesthesia in pediatric surgery center of Taihe Hospital, Hubei University of Medicine from Jan. 2018 to Jun. 2019 were randomly extracted to be divided into the control group and the experimental group via the random number table, with 41 cases in each group. The control group was given the rapid intravenous induction regimen for pediatric anesthesia (pentoxifylline hydrochloride 0.01 mg/kg, dexamethasone 0.1 mg/kg, desipramine 3 mg/kg, cisatracurium 0.1 mg/kg and fentanyl 4 μg/kg), and general anesthesia was maintained by placing the laryngeal mask with static inhalation. The experimental group received intravenous lidocaine 1 mg/kg and diprophylline 2 mg/kg before conventional induction regimen. Hemodynamic indicators, airway pressure and incidence of perioperative respiratory adverse events were compared between two groups at different time points. Results: There was no statistically significant difference in the heart rate between two groups at different time points (P>0.05), the difference in mean arterial pressure was statistically significant only when the laryngeal mask was removed (P<0.05), yet the difference in mean arterial pressure at other time points was not statistically significant (P>0.05). The airway pressure of the experimental group was significantly lower than that of the control group (P<0.05). The incidence of respiratory adverse events such as wheezing, oxygen saturation (SpO2) <90%, intraoperative coughing and breath-holding was 12.2% in the experimental group, significantly lower than 31.7% in the control group (P<0.05). Conclusion: Combined with other airway protection measures, preconditioning with lidocaine and diprophyllin before anesthesia have few effects on perioperative hemodynamic changes in children, which can reduce the intraoperative airway pressure and the incidence of respiratory adverse events, and ensure the safety of children. |
| Key words: bronchial hyperresponsiveness preconditioning bronchoalveolar lavage general anesthesia |
