经鼻导管微旁流式PETCO2监测在ERCP麻醉中的临床应用  

Clinical application of the microstream PETCO2 monitoring via the nasal catheter in patients undergoing ERCP under general anesthesia

作　　者：罗中辉 杨艳 唐惠 罗婕 向勇惠 胡啸玲[1] LUO Zhonghui;YANG Yan;TANG Hui;LUO Jie;XIANG Yonghui;HU Xiaoling(Department of Anesthesiology,The First Affiliated Hospital of University of South China,Hengyang 421001,China)

机构地区：[1]南华大学附属第一医院麻醉科,湖南衡阳421001

出　　处：《麻醉安全与质控》2020年第4期206-209,共4页Perioperative Safety and Quality Assurance

摘　　要：目的观察经鼻导管微旁流式呼气末二氧化碳分压(P ET CO2)监测能否预防经内镜逆行胰胆管造影术(ERCP)麻醉期间低氧血症的发生,并探讨其优缺点。方法选取我院肝胆外科2017-03/2019-05期间因胆道结石择期于非气管插管全身麻醉下行ERCP取石的患者240例,年龄40~65岁,体质量45~75 kg,ASA分级Ⅱ或Ⅲ级,随机分为试验组(经鼻导管吸氧,采用经鼻导管微旁流式P ET CO2监测患者肺通气,n=120)和对照组(仅经鼻导管吸氧,n=120)。两组患者均于置入十二指肠镜前10 min开始泵注瑞芬太尼0.04μg/(kg·min),直至手术结束。置镜前2 min给予丙泊酚1.5~2.0 mg/kg,待睫毛反射消失后置入十二指肠镜,置镜成功后予丙泊酚3~5 mg/(kg·h)持续泵注直至手术结束。观察并比较2组患者低氧血症(SpO 2<90%)发生率、托下颌率、挤压胸廓辅助呼吸率、面罩加压给氧率。结果两组患者性别比、年龄、BMI、手术时间、苏醒时间、丙泊酚用量等一般资料比较,差异无统计学意义(P>0.05);试验组患者低氧血症发生率、面罩加压给氧率低于对照组,差异有统计学意义(P<0.05),试验组托下颌率、挤压胸廓辅助呼吸率高于对照组,差异有统计学意义。结论经鼻导管微旁流式P ET CO2监测可实时指导我们对患者进行托下颌、挤压胸廓辅助呼吸处理,降低ERCP麻醉期间低氧血症的发生率和面罩加压给氧率。Objective To observe whether the microstream end-tidal carbon dioxide partial pressure(P ET CO2)monitoring via the nasal catheter can prevent the incidence of hypoxemia in patients undergoing endoscopic retrograde cholangiopancreatography(ERCP)under general anesthesia,and evaluate its advantages and disadvantages.Methods A total of 240 patients undergoing elective ERCP under general anesthesia,aged 40-65 years,weighting 45-75 kg,American Society of Anesthesiologists physical status beingⅡorⅢ,from March 2017 to May 2019,were selected and randomly divided into the experimental group(oxygen was inhaled via nasal catheter,and pulmonary ventilation was monitored by the microstream P ET CO 2 monitoring device,n=120)and the control group(only oxygen was inhaled via nasal catheter,n=120).In both groups,0.04μg/(kg·min)of remifentanil was pumped 10 min before the duodenoscopy was placed and continued until the end of surgery.Propofol was administered 1.5-2.0 mg/kg 2 min before the lens was placed.After the eyelash reflex disappeared,a duodenoscope was inserted.After the lens was successfully placed,propofol was continuously pumped at 3-5 mg/(kg·h)until the end of the surgery.The incidences of hypoxemia(SpO 2<90%),jaw-lift and chest compressions to aid breathing and the frequency of mask pressurization,in the two groups were compared.Results There was no significant difference in gender,age,body mass index,operation time,waking time and propofol dosage between the two groups(P>0.05).The incidence of hypoxemia and the frequency of mask pressurization in the experimental group were lower than those in the control group(P<0.05).The incidence of jaw-lift and chest compressions to aid breathing in the experimental group were higher than those in the control group(P<0.05).Conclusion The microstream P ET CO2 monitoring through the nasal catheter could guide anesthesiologists to lift jaw and chest compressions which could help to reduce the incidence of hypoxemia and the frequency of mask pressurization in patients undergoin

关 键 词：经内镜逆行胰胆管造影 经鼻导管微旁流式P ET CO2监测 低氧血症 

分 类 号：R614[医药卫生—麻醉学]