Kiểm soát đường thở trong nội soi đường hô hấp trẻ em tại Bệnh viện Sản Nhi Nghệ An=Airway control in respiratory tract endoscopy for children at Nghe An Obstetrics Pediatrics Hospital

0 Người đánh giá. Xếp hạng trung bình 0

Tác giả: Trọng Thông Lê, Xuân Hải Tăng, Minh Long Trần

Ngôn ngữ: vie

Ký hiệu phân loại:

Thông tin xuất bản: Y học cộng đồng, 2023

Mô tả vật lý: tr.259-266

Bộ sưu tập: Metadata

ID: 477595

Thêm vào giỏ

Đánh giá cách thức gây mê và khả năng kiểm soát tốt đường thở trong quá trình nội soi đường hô hấp ở trẻ em. Đối tượng - phương pháp nghiên cứu: Bệnh nhân trẻ em dưới 15 tuổi gồm 148 bệnh nhân nhập viện từ tháng 1 năm 2023 đến tháng 10 năm 2023
được chỉ định nội soi hô hấp do dị vật hay nội soi chẩn đoán, bệnh nhân có chỉ định lấy mẫu xét nghiệm dưới gây mê tại khoa gây mê hồi sức. Các dữ liệu theo dõi gồm: Tuổi bệnh nhân, giới tính, chẩn đoán bệnh, tình trạng phim x quang phổi trước khi soi
Trong quá trình gây mê: SpO2
nhịp tim, huyết áp
sự kích thích đường hô hấp trong quá trình gây mê
co thắt khí quản
bệnh nhân cần đặt nội khí quản thở máy sau khi soi
Thời gian hồi sức thở máy tiếp hay chỉ định rút nội khí quản sau khi nội soi đường hô hấp. Biến chứng sau trong khi soi hay sau khi soi được ghi nhận. Kết quả: Tất cả 148 bệnh nhân được gây mê tĩnh mạch propofol, gây tê lidocain hầu họng
Sau đó đặt dụng cụ soi thanh quản, khí quản, dụng cụ này có đường nối oxy cài đặt dòng cao vào phổi bệnh nhân. Các mục tiêu tiên quyết là gây mê đủ sâu, cung cấp đủ oxy cho bệnh nhân, giảm đau phù hợp khi soi, hạn chế các phản xạ hô hấp không mong muốn. Kết quả có 15 bệnh nhân, 10,1% co thắt thanh quản, phế quản. Trên 90% bệnh nhân tăng nhịp tim tăng trên 20% so với mức nền
86% bệnh nhân có tụt SpO2 từ 60-90%
sau đó tăng lên 98-100% khi có dòng oxy lưu lượng cao qua ống soi. Không có bệnh nhân biến chứng thủng khí quản gây tràn khí trung thất. Kỹ thuật soi phế quản ống cứng lấy dị vật: Có 16 bệnh nhân dị vật đường thở chiếm 10,8%
tất cả bệnh nhân đều được cứu sống
Nếu dị vật nhỏ, ở sâu nên dùng ống soi mềm hoặc kết hợp cả ống soi cứng và ống soi mềm. Số còn lại 138 bệnh nhân chiếm 89,2%. Kết luận: Nội soi đường hô hấp ở trẻ em cần gây mê toàn thân đủ sâu, gây tê bề mặt miệng, họng bằng lidocain
Quá trình thực hiện thủ thuật có nguy cơ tụt SpO2 (86% bệnh nhân)
nguy cơ cao co thắt khí phế quản
thừa CO2 hay có thể gây thủng phế quản gây tràn khí trung thất. Cần có kíp gây mê thành thạo và các phương tiện cấp cứu khác đầy đủ nhất.Evaluate the anesthesia method and the ability to control the airway during respiratory endoscopy in children. Subjects - methods: Children under 15 years old include 148 patients hospitalized from January 2023 to October 2023
Indicated for respiratory endoscopy due to foreign bodies or diagnostic endoscopy, the patient is indicated to have samples taken for testing under anesthesia at the anesthesia and resuscitation department. Monitoring data includes: Patient age, gender, disease diagnosis, chest x-ray status before screening
During anesthesia: SpO2
heart rate, blood pressure
irritation of the respiratory tract during anesthesia
tracheal spasm
Patients requiring endotracheal intubation and mechanical ventilation after endoscopy
Time for continued mechanical ventilation resuscitation or indication for endotracheal extubation after respiratory endoscopy. Complications during or after surgery were recorded. Results: All 148 patients received propofol intravenous anesthesia, oropharyngeal lidocain anesthesia
Then place a tracheoscope, this instrument has an oxygen connection to install high flow into the patient's lungs. The prerequisite goals are deep enough anesthesia, providing enough oxygen to the patient, appropriate pain relief during examination, and limiting respiratory reflexes. As a result, 15 patients had laryngospasm and bronchospasm in 10.1%. Over 90% of patients had increased heart rate over 20% compared to the baseline level
86% of patients had SpO2 drop from 60-90%
then increases to 98-100% when high flow of oxygen added through the scope. Rigid bronchoscopy technique to remove foreign bodies: There were 16 patients with foreign bodies in the airways, accounting for 10.8%
all patients were saved
If the foreign bodie is small and deep, you should use a flexible scope or a combination of both a rigid scope and a flexible scope. The remaining 138 patients account for 89.2%
diagnostic and interventional endoscopy with preparation. Conclusions: Respiratory endoscopy in children requires deep general anesthesia, anesthetizing the mouth and throat surface with lidocaine
The procedure carries a risk of low SpO2 (86% of patients)
high risk of tracheobronchial spasm
Excess CO2 and cause bronchial perforation and pneumomediastinum. It is necessary to have a good skilled anesthesia team and the most complete emergency equipment.

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