常规密闭机械通气在全麻下支气管镜介入治疗中的应用研究  

Study of conventional mechanical ventilation for interventional bronchoscopy under general anesthesia

作　　者：丁彦[1] 张杰[1] 尹凤先[1] 王婷[1] 徐敏[1] 王娟[1] 裴迎华[1] 

机构地区：[1]首都医科大学附属北京天坛医院呼吸科,100050

出　　处：《国际呼吸杂志》2011年第22期1700-1705,共6页International Journal of Respiration

基　　金：北京市卫生局首都医学发展科研基金（2007-3099）

摘　　要：目的通过经气管插管对常规密闭机械通气的健康犬施行支气管镜模拟介入治疗，观察气管镜插入前后呼吸机参数及动脉血气分析的变化情况，以期寻求在常规密闭机械通气的条件下实施支气管镜介入治疗时所需要的适宜的气管通道及呼吸机参数。方法健康杂种犬1O只，全麻和肌松状态下气管插管、常规密闭机械通气，稳定后将直径6．0mm的支气管镜插入气管插管。观察换用不同口径气管插管（内径7．0mm、7．5mm及8．5ram）后呼吸机参数（潮气量、吸气峰压）及动脉血气分析（pH、Pa0：及PaCO2）的变化情况。结果应用直径6．0mm的治疗型支气管镜插入气管插管内进行操作时，气管插管的内径应≥7．5mm才不致产生过高的气道压而影响通气效果，并于术中维持较满意的pH、PaO2和PaCO2。为避免气压伤的危险，应调整呼吸机高压报警限在安全范围，允许一定程度的通气量置入不足及由此导致的一定程度的高碳酸血症。负压吸引时，随着负压吸引时间延长，会出现明显的低氧血症及进行性的CO2潴留，应注意控制负压吸引时间。减轻麻醉深度，患者恢复自主呼吸后，负压吸引对PaO2和PaCO2的影响降低。结论全麻和肌松状态下常规密闭机械通气时进行支气管镜介入治疗，选择内径7．5mm以上的气管通道（气管插管或喉罩），可维持较满意的PaO2和PaCO2，安全可靠，是一种非常适合中国国情的支气管镜介入治疗途径，在绝大多数情况下可取代开放通气条件下的硬质支气管镜途径，不但经济实用，而且易于推广。Objective In this experiment, healthy dogs were intuhated with endotracheal tube, simulated interventional bronchoscopy was performed with the support of assist-control ventilation. Observations concerning the alternations of respiratory parameters and blood gas analysis were made to detect the proper tracheal passage and respiratory parameters for interventional bronchoscopy under conventional mechanical ventilation. Methods Ten healthy mongrel dogs were used in this experiment. Each dog was intubated with an endotraeheal tube and mechanically ventilated. After the induction o{ general anesthesia and muscle relaxation, a bronchoseope （6.0 mm external diameter） was inserted into the endotracheal tube until the respiratory status was stable. Endotracheal tubes in different sizes were used, and the variations o{ the ventilamry parameters （tidal volume, peak inspiratory pressure） and the arterial blood gas analysis （pH, PaO2 and PaCO2 ） which correlated to the different sizes of the endotracheal tube（7.0 mm,7.5 mm and 8.5 mm internal diameter） were recorded. Results The internal diameter of the endotracheal tube should be no less than 7.5 mm when a 6.0 mm external diameter bronchoscope （therapeutic hronchoscope） was used, in order to prevent exceeding high airway pressure and maintain satisfied pH, PaO2 and PaCO2 during the procedure. In order to prevent barotrauma, the high pressure alarm setting should be within the security level, permit some extent of ventilation inadequacy and a degree of hypercapnia. Suctioning time should be controlled, as obvious hypoxemia and progressive carbon dioxide retention may emerge as the suction prolonged. However, such alternation in blood gas analysis was not so obvious when the depth of anesthesia was alleviated to reserve spontaneous breathing. Conclusions It is indicated that endotracheal tube larger than 7.5 mm could guarantee satisfied PaO2 and PaCO2 during interventional bronchoscopy, which is supported by conventional mechanical ventilation under genera

关 键 词：气管插管 机械通气 支气管镜介入治疗 血气分析 负压吸引 

分 类 号：R614[医药卫生—麻醉学]