在面罩通气自主呼吸的全身麻醉下为弥漫性肺泡出血的儿童进行支气管镜检查

Ruimin Yang, Qing Wei, Xun Chen, Jing Liu, Yan Li, Jingchen Liu
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摘要

目的:提高弥漫性肺泡出血(DAH)患儿支气管镜检查期间全身麻醉的管理水平。方法:对接受过支气管镜检查的弥漫性肺泡出血患儿进行回顾性研究:对我院2021年6月至2022年6月最初在面罩通气自主呼吸全身麻醉下进行支气管镜检查的DAH患儿进行回顾性研究。研究结果1.34 名儿童接受了 38 次支气管镜检查。2.所有手术均采用异丙酚静脉注射进行全身麻醉诱导。为了维持麻醉,31例手术(81.6%)同时静脉注射了异丙酚和瑞芬太尼,其余7例手术(18.4%)仅静脉注射了异丙酚。有 21 例手术(55.3%)使用氯胺酮或丙泊酚静脉注射作为麻醉辅助剂。35例手术(92.1%)在无气管插管通气的情况下顺利完成,其余3例手术(7.9%)需要改为气管插管通气。3.7 例手术(18.4%)出现呼吸抑制,2 例手术(2.6%)出现喉痉挛,17 例手术(44.7%)出现支气管痉挛。16例手术(42.1%)出现术中低氧血症。与处于疾病缓解期的手术相比,处于疾病活动期的手术术中低氧血症的发生率明显更高(P<0.05)。16例手术(42.1%)出现术中高碳酸血症。两例手术(5.3%)并发严重肺出血。结论面罩通气配合自主呼吸的全身麻醉对于接受支气管镜检查的 DAH 患儿是可行且相对安全的,但麻醉方案仍需改进。
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Bronchoscopy in children with diffuse alveolar hemorrhage under general anesthesia with spontaneous respiration by face mask ventilation
Purpose: To improve the management level of general anesthesia during bronchoscopy in the children with diffuse alveolar hemorrhage (DAH). Methods: A retrospective study was conducted in the children with DAH who had performed bronchoscopy under general anesthesia with spontaneous respiration by face mask ventilation initially from June 2021 to June 2022 in our hospital. Results: 1. Thirty-four children who had underwent 38 bronchoscopy procedures were included. 2. General anesthesia induction was performed by bolus of propofol intravenous in all the procedures. For maintaining anesthesia, 31 procedures (81.6%) received both propofol and remifentanil intravenously infusion and the rest 7 procedures (18.4%) received propofol intravenously infusion only. An intravenous bolus of ketamine or propofol was given as an anesthetic adjuvant in 21 procedures (55.3%). Thirty-five procedures (92.1%) were successfully completed under non-tracheal intubation ventilation, whereas the rest 3 procedures (7.9%) needed change to tracheal intubation ventilation. 3. Respiratory depression was found in 7 procedures (18.4%), laryngospasm was found in 2 procedure (2.6%) and bronchospasm was found in 17 procedures (44.7%). Sixteen procedures (42.1%) developed intraoperative hypoxemia. The incidence of intraoperative hypoxemia in the procedures at the active phage of disease was significantly higher compared to those at the remission phage of the disease (P<0.05). Sixteen procedures (42.1%) developed intraoperative hypercapnia. Two procedures (5.3%) were complicated by severe pulmonary hemorrhage. Conclusions: General anesthesia with spontaneous respiration by face mask ventilation is feasible and relatively safe for the children with DAH undergoing bronchoscopy, whereas the anesthetic protocol still needs to be improved.
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