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上海市卫生健康委员会
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喷射通气在支撑喉镜手术中的应用
The use of jet ventilation in suspended laryngoscopy

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DOI:
作者:
谭放,李绍清,陈莲华,缪长虹
TAN Fang, LI Shao-qing, CHEN Lian-hua, MIAO Changh
作者单位:
复旦大学眼耳鼻喉科医院麻醉科
Eye Ear Nose and Throat Hospital
关键词:
麻醉 ;喉镜检查;高频喷射通气 ;间歇正压通气
Anesthesia; Laryngoscopy;High-frequency jet ventilation; Intermittent positive-pressure ventilation
摘要:
目的：全麻及肌松条件下比较行不同频率喷射通气与间歇正压控制通气在支撑喉镜手术时的通气变化及临床效果。方法:选择择期行支撑喉镜下手术病人80例，ASA I或Ⅱ级，随机平均分为高频喷射通气组（H1组,频率为60次/分；H2组，频率为150次/分)，常频喷射通气组（C组，频率20次/分）和间歇正压控制通气组(I组)。四组患者均采用以芬太尼3～4ug／kg，异丙酚2.5～3.0 mg／kg，琥珀胆碱1.5～2.0 mg／kg静脉注射诱导, 术中间断追加异丙酚及琥珀胆碱维持麻醉。H1、H2 和C组喷射通气组经鼻插入喷射管至气管内与喷射通气机相接行喷射通气，I组经口明视下插入小口径气管导管 (内径5．5～6．0mm) 接麻醉机行控制呼吸。麻醉前行足背动脉穿刺用测压及血气分析采样。记录4组患者麻醉前(T0)、气管插管时(T1)、放置支撑喉镜时(T2)、通气10分钟(T3)、拔管时(T4)及拔管后10分钟(T5)时的平均动脉压(MBP)、心率（HR）、氧饱和度（SpO2）及动脉血气分析结果，并记录麻醉累计用药量、苏醒时间、有无声带振动及拔管时躁动等情况。结果：4组在T3的PH值及PaCO2与T0比有显著性差异，其中H2组尤为明显； 4组在T2时血压比T0明显升高，心率明显下降,T4心率及血压明显比T3升高(P<0.01)，其中I组在T4血压升高幅度较其他三组尤为显著(P<0.01)；4 组在T3及T5的PH值较术前明显降低，而PaCO2则明显升高(P <0．01)，其中H2组的改变较其他三组尤为显著(P<0.01)；I组拔管时躁动比其他3组明显增加,C组术中声带振动比其他3组明显增加。结论：在支撑喉镜手术时，细喷射导管行频率60次/分的高频喷射通气既能提供清晰的手术视野，又能保证良好的通气效果，是一种较理想的通气方法。
Objective: A double-blind randomized clinical trial was performed to investigate the effect of there kinds of jet ventilation with a thin transnasal catheter in suspended laryngoscopic surgery. Methods: 80 ASA I or Ⅱ patients scheduled for laryngoscopic surgery were randomly and averagely divided into four groups: high-frequency jet ventilation (HFJV) groups (group H1, f=60bpm and group H2, f=150bpm), low-frequency jet ventilation(LFJV) group (group C, f=20bpm) and intermittent positive-pressure ventilation (IPPV) group (group I). After induction of anesthesia with fentanyl 3～4μg/kg，propofol 2.5～3.0 mg/kg，succinylcholine 1.5～2.0 mg/kg, IPPV was applied after tracheal intubation with ID 6.0mm tracheal tube in group I, while in the groups H1,H2 and C a jet tube modified by a thin suction catheter were inserted transnasally into the trachea and connected to the machine of jet ventilation. Anesthesia was maintained by intermittent injection of propofol and succinylcholine in all four groups. Information including heart rate(HR), mean blood pressure (MAP), SPO2 and blood gas analysis was recorded at a serie of time points: before induction (T0), during intubation (T1), laryngoscope suspending(T2), 10 minutes after the onset of ventilation(T3), during extubation (T4) and 10 minutes after extubation (T5). And all complications were also recorded.Results: In all groups, MAP increased and HR decreased significantly in T2 (P<0.01). MAP and HR increased significantly in T4 (P<0.01), especially in the group I. PaCO2 increased and PH decreased significantly in T3 and T5(P<0.01), especially in the group H2. The rate of side effects increased significantly in group I than those in the other groups, and vocal cords libration increased significantly in group C.Conclusion：During laryngoscopic surgery ，HFJV (f=60bpm) through a thin transnasal tube can not only provide excellent surgical view, but also maintain adequate ventilation．It may be a ventilation method of choice for suspended laryngoscopy．

 

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