新型鼻咽通气道联合改良通气手法在高体质指数患者中的应用  

Application of the new nasopharyngeal airway combined with modified ventilation maneuver in patients with high body mass index

作　　者：马艳丽[1] 张思茹 王艳红[1] MA Yanli;ZHANG Siru;WANG Yanhong(Department of Anesthesiology and Perioperative Medicine,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]郑州大学第一附属医院麻醉与围术期医学部,450000

出　　处：《临床麻醉学杂志》2021年第11期1172-1176,共5页Journal of Clinical Anesthesiology

摘　　要：目的探究新型鼻咽通气道联合改良通气手法在高体质指数患者人工通气中使用的有效性,进而评估此通气策略在该人群人工通气中替代面罩通气的可行性。方法择期气管插管全麻手术患者118例,年龄18~55岁,BMI>26 kg/m^(2),ASAⅠ或Ⅱ级,Mallampati分级Ⅰ或Ⅱ级。根据通气方法随机分为鼻咽通气道组(N组,n=58)和面罩组(M组,n=60)。诱导期患者意识消失后,N组经鼻腔插入新型鼻咽通气道,并使用改良通气手法封闭口腔和另一侧鼻腔,M组行EC手法面罩通气,通气3 min后行气管插管术。记录麻醉诱导前,自主呼吸消失后1、2、3 min,气管插管后即刻的膈肌呼吸运动幅度、HR、SBP、DBP、SpO_(2)。记录自主呼吸消失后1、2、3 min,气管插管后即刻的P_(ET)CO_(2)、Ppeak。记录HR、SBP、DBP波动幅度超过基础值30%或SBP低于80 mmHg、鼻黏膜损伤、呕吐误吸、SpO_(2)<90%的发生情况。结果自主呼吸消失后1、2、3 min N组膈肌呼吸运动幅度均明显大于M组(P<0.05)。两组不同时点HR、SBP、DBP、SpO_(2)、P_(ET)CO_(2)、Ppeak差异无统计学意义,HR、SBP、DBP波动幅度超过基础值30%或SBP低于80 mmHg发生率及鼻黏膜损伤发生率差异无统计学意义,两组均未见呕吐误吸、SpO_(2)<90%等情况。结论新型鼻咽通气道联合改良通气手法在高体质指数患者人工通气中通气效果优于面罩通气,此通气策略为高体质指数患者有效人工通气提供了新的选择。Objective To investigate the effect of the new nasopharyngeal airway combined with modified ventilation maneuver in artificial ventilation of patients with high body mass index,then evaluate the feasibility of the ventilation strategy in the replacement of mask ventilation in artificial ventilation of this population.Methods One hundred and twenty patients,aged 18-55 years,with a BMI>26 kg/m^(2),falling into ASA physical statusⅠorⅡ,with a Mallampati classificationⅠorⅡ,scheduled for general anesthesia with endotracheal intubation,were randomly divided into nasopharyngeal airway group(group N)and mask group(group M)according to different ventilation methods,60 cases of each group.After patients lost consciousness in the induction period,new nasopharyngeal airway was inserted via the nasal cavity combined with the mouth cavity and opposite nostril closed for ventilation in group N,using the modified ventilation maneuver,and mask ventilation was performed using EC-clamp technique in group M,the patients were tracheally intubated after ventilted for 3 minutes.Before induction of anesthesia,1,2,and 3 minutes after no spontaneous breathing and immediately after intubation,ultrasound was used to measure the amplitude of diaphragm motion induced by respiratory movement,HR,SBP,DBP and SpO_(2)were recorded.1,2,and 3 minutes after no spontaneous breathing and immediately after intubation,P_(ET)CO_(2)and Ppeak were recorded.Fluctuation in HR,SBP,DBP≥30%of baseline before operation or SBP<80 mmHg and nasal mucosal injury,vomiting,aspiration,SpO_(2)<90%were also recorded.Results The amplitude of diaphragm motion induced by respiratory movement at 1,2,and 3 minutes after no spontaneous breathing in group N was significantly higher than that in group M(P<0.05).The difference of HR,SBP,DBP,SpO_(2),P_(ET)CO_(2)and Ppeak at different time points between the two groups were not significant,no significant difference in the incidence of fluctuation in HR,SBP,DBP≥30%of baseline before operation or SBP<80 mmHg and nasal mucos

关 键 词：人工通气 新型鼻咽通气道 面罩通气 

分 类 号：R614[医药卫生—麻醉学]