不同麻醉通气方式对经支气管冷冻肺活检患者影响的前瞻性随机对照研究  

The impacts of the different ventilation methods on patients with transbronchial cryobiopsy: a prospective randomized controlled trial

作　　者：陈小波[1] 姚遥 叶永顺 钟南山[1] 李时悦[1] 卢丽雅[2] CHEN Xiaobo;YAO Yao;YE Yongshun;ZHONG Nanshan;LI Shiyue;LU Liya(State Key Laboratory of Respiratory Disease,National Clinical Research Center for Respiratory Disease,Guangzhou Institute of Respiralory Health,The First Afliated Hospital of Guangzhou Medical University,Guangzhou,Guangdong 510120,P.R.China;Department of Anesthesia,The First Afiliated Hospital of Guangzhou Medical University,Guangzhou,Guangdong 510120,P.R.China)

机构地区：[1]广州医科大学附属第一医院呼吸内科广州呼吸健康研究院呼吸疾病国家重点实验室国家呼吸系统疾病临床医学研究中心,广东广州510120 [2]广州医科大学附属第一医院麻醉科,广东广州510120

出　　处：《中国呼吸与危重监护杂志》2021年第2期123-127,共5页Chinese Journal of Respiratory and Critical Care Medicine

基　　金：广东省医学科学技术研究基金(A2020134)。

摘　　要：目的探讨全身静脉麻醉气管插管接常频通气和插入硬质支气管镜接高频通气下对经支气管冷冻肺活检(TBCB)患者的影响。方法采用前瞻性随机对照研究,对2018年8月至2019年2月在广州医科大学附属第一医院行TBCB的间质性肺疾病(ILD)患者进行研究,根据麻醉插管通气方式的不同随机分成气管插管接常频通气(TI-CV)组和硬质支气管镜(RB-HFV)组,比较不同麻醉通气插管方式下两组患者的手术时间、拔管时间、总麻醉时间、术中血压、心率波动情况以及动脉血气的变化。结果共65例ILD患者入选,TI-CV组33例,RB-HFV组32例,平均年龄分别为(48.0±15.0)和(48.8±10.8)岁(P=0.803)。两组患者术前体重指数、肺功能(FEV_(1)、FVC、FEV_(1)/FVC、D_(L)CO)、动脉血气(pH、PaO_(2)、PaCO_(2))以及心率、平均动脉压(MAP)等基础指标均无显著差异。TI-CV组和RB-HFV组术后5min动脉血pH分别为7.34±0.06和7.26±0.06,PaCO_(2)分别为(48.82±9.53)和(62.76±9.80)mmHg,差异均有统计学意义(P=0.000)。术毕时TI-CV组和RB-HFV组患者动脉血pH分别为7.33±0.06和7.21±0.08,PaCO_(2)分别为(48.91±10.49)和(70.93±14.83)mmHg,心率分别为(79.6±21.1)和(93.8±18.7)次/min,MAP分别为(72.15±13.03)和(82.63±15.65)mmHg,差异均有统计学意义(P<0.05)。TI-CV组和RB-HFV组手术时间、拔管时间无显著差异,麻醉总时间为(47.4±8.8)和(53.3±11.6)min,差异有统计学意义(P=0.017)。术后麻醉完全复苏拔管5min后动脉血气(pH、PaO_(2)、PaCO_(2))以及心率、MAP均无显著差异。两组患者均未发生严重并发症。结论全身静脉麻醉气管插管接常频通气下TBCB较插入硬质支气管镜接高频通气下TBCB更有利于保持术中有效通气,维持心率以及MAP的稳定,建议对心肺功能较差的患者采用全身静脉麻醉气管插管接常频通气下行TBCB更有利于手术安全。Objective To evaluate the difference between the tracheal intubation connected to conventional ventilation(TI-CV) and rigid bronchoscopy connected to high frequency ventilation(RB-HFV) under general anesthesia on patients with transbronchial cryobiopsy(TBCB). Method A prospective, randomized, controlled trial was conducted in interstitial lung disease patients with TBCB from August 2018 to February 2019 in the First Affiliated Hospital of Guangzhou Medical University. According to the different methods of intubation, the patients were divided to a TI-CV group and a RB-HFV group randomly. The operating duration, extubation duration, total anesthesia time, heart rate,blood pressure and arterial blood gas analysis were collected and analyzed. Results Sixty-five patients were enrolled.There were 33 patients with an average age of(48.0±15.0) years in TI-CV group and 32 patients with an average age of(48.8±10.8) years in RB-HFV group. The basic line of body mass index, pulmonary function(FEV1, FVC and DLCO),arterial blood gas(pH, PaO_(2) and PaCO_(2)) and heart rate(HR), mean arterial pressure(MAP) had no significant differences between two groups. At the first 5 minutes of operation, the pH was(7.34±0.06) and(7.26±0.06), and the PaCO_(2) was(48.82±9.53) and(62.76±9.80) mm Hg in TI-CV group and RB-HFV group respectively, with significant differences(P=0.000). At the end of operation, the pH was(7.33±0.06) and(7.21±0.08), the PaCO_(2) was(48.91±10.49) and(70.93±14.83) mm Hg, the HR were(79.6±21.1) and(93.8±18.7) bpm, the MAP were(72.15±13.03) and(82.63±15.65)mm Hg in TI-CV group and RB-HFV group respectively, with significant differences(P<0.05). There were no differences in the operating duration and extubation duration between two groups. The total anesthesia time was(47.4±8.8) and(53.3±11.6) min with significant difference(P=0.017). Five minutes after the extubation, there were no significant difference in the pH, PaO_(2), PaCO_(2), HR and MAP between two groups. No serious complications occurred in e

关 键 词：麻醉 气管插管 硬质支气管镜 冷冻肺活检 动脉血气 

分 类 号：R614[医药卫生—麻醉学]