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目的总结小儿纵隔肿瘤活检手术麻醉管理的临床经验。方法对1例纵隔肿瘤患儿行局部麻醉下活检术,因患儿不合作,故实施气管内插管全麻。对此例患儿术前评估、麻醉方法的选择及并发症处理进行总结分析。结果本例3岁患儿,因发现纵隔占位性病变15 d入院。自患病以来,家长自诉未见明显呼吸困难,可平躺。胸部CT示前纵隔占位,气管受压。患儿静脉诱导插管后,出现潮气量降低、气道压增高,PETCO2波形消失。考虑全麻后发生肿瘤压迫气道梗阻,予改变体位为右侧卧位后症状缓解,后于右侧卧位完成穿刺活检术。结论此类患儿的麻醉风险较高,其术前评估、麻醉方式选择和围术期管理十分重要,避免呼吸道梗阻、保持循环稳定是儿童纵隔肿瘤活检手术成功的重要保证。
Objective To summarize the clinical experience of anesthesia management in pediatric mediastinal tumor biopsy. Methods One case of mediastinal tumor patients underwent local anesthesia biopsy, because children do not cooperate, so the implementation of endotracheal intubation general anesthesia. This case of children with preoperative evaluation, selection of anesthesia methods and complications of treatment were summarized. The results of this case of 3-year-old children, because of the discovery of mediastinal space-occupying lesions 15 d admission. Since the onset of illness, parents have no obvious respiratory problems in private prosecution, lying flat. Chest CT showed anterior mediastinal mass, tracheal pressure. Children with intravenous intubation, tidal volume decreased, increased airway pressure, PETCO2 waveform disappears. Consider the occurrence of tumor compression after general anesthesia airway obstruction, to change the position for the right lateral recumbent symptoms, after the completion of the right lateral puncture biopsy. Conclusion Such children have a higher risk of anesthesia. It is very important to evaluate their preoperative evaluation, choice of anesthesia and management of perioperative period. Avoiding airway obstruction and maintaining circulatory stability are important guarantees for successful operation of children with mediastinal tumor biopsy.