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轻柔的胸部按压可缓解儿童拔管后喉痉挛。

Gentle chest compression relieves extubation laryngospasm in children.

机构信息

Department of Anesthesiology, Faculty of Medicine, Dammam University, Dammam, Saudi Arabia.

出版信息

J Anesth. 2010 Dec;24(6):854-7. doi: 10.1007/s00540-010-1036-9. Epub 2010 Oct 26.

DOI:10.1007/s00540-010-1036-9
PMID:20976504
Abstract

PURPOSE

Extubation laryngospasm is frequently encountered in children undergoing upper airway surgery. Different drugs and techniques have been used for its treatment. The objective of this study was to examine gentle chest compression as an alternative to standard practice for relief of laryngospasm.

METHODS

This study was conducted over 4 years on all children scheduled for elective tonsillectomy. During the first 2 years, extubation laryngospasm was managed with 100% O₂ with gentle positive pressure ventilation via a tight-fitting face mask (Standard-Practice Group), whereas in the following 2 years; laryngospasm was managed with 100% O₂ and concurrent gentle chest compression (Chest-Compression Group). In both groups, if the spasm was not relieved and oxygen saturation decreased to 85%, IV succinylcholine was administered with subsequent manual ventilation.

RESULTS

During the 4-year study period, 1226 children aged 3-12 years were studied. In the chest-compression group, 46/594 children (7.8%) developed laryngospasm compared with 52/632 children (8.2%) in the standard group (P = 0.84). Significantly more children who developed laryngospasm were successfully treated by chest compression 34/46 (73.9%) compared with those managed by the standard method 20/52 (38.4%); (P < 0.001). None of the children in the chest-compression group developed gastric distension compared with 45/52 (86.5%) in the standard group.

CONCLUSION

Gentle chest compression with 100% oxygen is a simple and effective technique for immediate management of post extubation laryngeal spasm in children.

摘要

目的

小儿行上气道手术后常发生拔管性喉痉挛。不同的药物和技术已被用于其治疗。本研究的目的是研究轻柔的胸部按压作为缓解喉痉挛的替代标准方法。

方法

这项研究在 4 年内对所有择期行扁桃体切除术的儿童进行了研究。在前 2 年中，通过紧密贴合面罩给予 100%氧气和温和的正压通气来管理拔管性喉痉挛（标准实践组），而在后 2 年中；通过 100%氧气和同时进行的轻柔胸部按压来管理喉痉挛（胸部按压组）。在这两组中，如果痉挛未缓解且氧饱和度降至 85%以下，则给予 IV 琥珀酰胆碱，随后进行手动通气。

结果

在 4 年的研究期间，对 1226 名年龄为 3-12 岁的儿童进行了研究。在胸部按压组中，与标准组的 52/632 名儿童（8.2%）相比，46/594 名儿童（7.8%）发生了喉痉挛（P = 0.84）。与用标准方法治疗的 20/52 名儿童（38.4%）相比，通过胸部按压成功治疗的发生喉痉挛的儿童显著更多，34/46（73.9%）；（P < 0.001）。与标准组的 45/52（86.5%）相比，胸部按压组无一例儿童发生胃扩张。

结论

在儿童中，用 100%氧气进行轻柔的胸部按压是一种简单而有效的方法，可立即处理拔管后喉痉挛。

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本文引用的文献

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Reflex respiratory stimulation by chest compression in the dog.犬胸部按压引起的反射性呼吸刺激。
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Eur J Transl Myol. 2022 Jun 29;32(3):10581. doi: 10.4081/ejtm.2022.10581.
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