不同频率喷射通气在支撑喉镜术中的通气效果及不良反应  

Ventilatory effect and adverse response of jet ventilation at different frequencies in suspension laryngoscopy

作　　者：谭放[1] 李绍清[1] 陈莲华[1] 缪长虹[2] 

机构地区：[1]复旦大学附属眼耳鼻喉科医院麻醉科,上海200031 [2]复旦大学附属中山医院麻醉科

出　　处：《上海医学》2010年第10期915-918,共4页Shanghai Medical Journal

摘　　要：目的全身麻醉肌松条件下比较不同频率喷射通气与间歇正压通气在支撑喉镜术中应用的通气效果及不良反应。方法选择择期行支撑喉镜下手术的患者80例,美国麻醉医师学会分级Ⅰ或Ⅱ级,随机均分为高频喷射通气组(H1组,频率为60次/min;H2组,频率为150次/min)、常频喷射通气组(C组,频率为20次/min)和间歇正压控制通气组(I组)。4组患者均以芬太尼3～4μg/kg、丙泊酚2.5～3.0mg/kg、琥珀胆碱1.5～2.0mg/kg静脉注射行麻醉诱导,术中间断追加丙泊酚及琥珀胆碱维持麻醉。H1、H2和C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置入G22套针用于监测血压及血气分析采样。记录4组患者麻醉前(T0)、气管插管(T1)、放置支撑喉镜(T2)、通气10min(T3)、拔管(T4)及拔管后10min(T5)的平均动脉压(MAP)、心率(HR)、脉搏血氧饱和度(SpO2)及动脉血气分析结果,并记录麻醉累计用药量、苏醒时间、有无术中声带振动及拔管时躁动等情况。结果 4组在T3、T5时间点的动脉血氧分压(paO2)、动脉血二氧化碳分压(paCO2)显著高于同组T0时间点(P值均<0.01),pH值显著低于同组T0时间点(P值均<0.01);H2组在T3时间点的pH值和paCO2的改变较其他3组更为显著(P值均<0.01);4组在T2时间点的MAP均较同组T1时间点显著升高(P值均<0.01),HR显著下降(P值均<0.01);4组在T4时间点的HR及MAP均比同组T3时间点显著升高(P值均<0.01)。I组拔管时躁动比例显著高于其他3组(P值均<0.01),C组术中声带振动比例显著高于其他3组(P<0.01)。结论在支撑喉镜手术时,行频率为60次/min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,且不良反应发生率最低,是一种较理想的通气方法。Objective A double-blinded randomized clinical trial was performed to investigate the ventilatory effect and adverse response of jet ventilation at three different frequencies with a thin transnasal catheter in suspended laryngoscopic surgery.Methods A total of 80 American Society of Anesthesiologists grade Ⅰ or Ⅱ patients scheduled for laryngoscopic surgery were evenly randomized into four groups：high-frequency jet ventilation（HFJV）groups（group H1,f=60 bpm and group H2,f=150 bpm）,low-frequency jet ventilation（LFJV）group（group C,f=20 bpm）and intermittent positive-pressure ventilation（IPPV）group（group I）.After induction of anesthesia with fentanyl（3-4 μg/kg）,propofol（2.5-3.0 mg/kg）,succinylcholine（1.5-2.0 mg/kg）,IPPV was applied after tracheal intubation with ID 6.0 mm tracheal tube in group I;in the groups H1,H2 and C a jet tube modified by a thin suction catheter was inserted transnasally into the trachea and connected to jet ventilation device.Anesthesia was maintained by intermittent injection of propofol and succinylcholine in all four groups.The heart rate（HR）,mean artery pressure（MAP）,saturation pulse oxygen（SPO2）and blood gas analysis were recorded at defined 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）.The adverse responses,including cardiovascular reflex,CO2 retention and vocal cord vibration,were also recorded.Results The values of pressure of arterial oxygen（paO2）,pressure of arterial carbon dioxide（paCO2）at T3 and T5 were significantly higher than those at T0 in all the 4 groups（all P0.01）,and the pH value was significantly lower than that at T0（all P0.01）;the changes in H2 group were more significantly than those in the other 3 groups.The value of MAP increased and that of HR decreased significantly at T2 compared with that at T1 in the 4 groups（all P0.01）.Compa

关 键 词：支撑喉镜 高频喷射通气 间歇正压通气 

分 类 号：R614[医药卫生—麻醉学]