喉罩联合气道狭窄远端细管通氧用于严重气道狭窄患者气管镜诊疗术中通气的效果  

Efficacy of constant flow oxygen supply via laryngeal mask airway combined with a thin tube at distal end of airway stenosis for intraoperative ventilation in patients with severe tracheal stenosis undergoing bronchoscopy

作　　者：房兰天 张保军[1] 李宁[1] 刘胜群[2] 胡振华[2] Fang Lantian;Zhang Baojun;Li Ning;Liu Shengqun;Hu Zhenhua(Department of Anesthesiology,Xinxiang Central Hospital,Xinxiang 453000,China;Department of Anesthesia and Perioperative Medicine,Henan Province People's Hospital,Zhengzhou 450003,China)

机构地区：[1]新乡市中心医院麻醉科,453000 [2]河南省人民医院麻醉与围术期医学科,郑州450003

出　　处：《中华麻醉学杂志》2021年第12期1495-1497,共3页Chinese Journal of Anesthesiology

摘　　要：目的评价喉罩联合气道狭窄远端细管通氧用于严重气道狭窄患者气管镜诊疗术中通气的效果。方法选择因气道狭窄行气管镜下综合介入治疗术的患者40例,性别不限,年龄18~70岁。采用随机数字表法分为2组(n=20):试验组和对照组。常规麻醉诱导,置入喉罩,连接四通接头和麻醉机行间歇正压通气。试验组置入喉罩后经四通接头一端向气道狭窄远端置入6Fr吸痰管,1 L/min通入氧气。于细管通气前(T0)、机械通气开始后30 min(T_(1))、手术结束(T_(2))时记录SpO_(2)、PETCO_(2)、平均气道压(Pmean)、每分钟通气量(MV),并实施肺电阻抗成像监测,记录中心通气区(CoV)、依赖静止区(DSS)、非依赖静止区(NSS)的面积百分比。于T_(1)时行血气分析,记录pH值、PaO_(2)和PaCO_(2)。记录通气期间低氧血症发生情况。结果与对照组比较,试验组T_(1,2)时MV、Pmean、NSS面积百分比升高,DSS面积百分比降低,T_(1)时P_(ET)CO_(2)降低,SpO_(2)和CoV面积百分比升高,pH值、PaO_(2)升高,PaCO_(2)降低,低氧血症发生率降低(P<0.05)。结论喉罩联合气道狭窄远端细管通氧可增加狭窄远端氧浓度,同时使狭窄远端部分萎陷肺组织复张,改善严重气道狭窄患者气管镜介入治疗术中通气效果。Objective To evaluate the efficacy of constant flow oxygen supply via laryngeal mask airway combined with a thin tube at the distal end of airway stenosis for intraoperative ventilation in the patients with severe tracheal stenosis undergoing bronchoscopy.Methods Forty patients of either sex,aged 18-70 yr,scheduled for comprehensive interventional therapy with tracheoscope for severe tracheal stenosis,were allocated into 2 groups(n=20 each)by a random number table method:test group and control group.After routine anesthesia induction,intermittent positive pressure ventilation was supplied via a laryngeal mask airway linked to four-way connector and anesthesia machine.In test group,a 6Fr suction tube was inserted through the four-way connector and placed at the distal end of the stenosis,with 1 L/min flow oxygen supply.Before ventilation with the thin tube(T_(0)),at 30 min after start of mechanical ventilation(T_(1)),and at the end of operation(T_(2)),SpO_(2),PETCO_(2),mean airway pressure(Pmean),and minute ventilation(MV)were recorded,monitoring of lung ventilation was implemented using electrical impedance tomography,and the area percentages of the centre of ventilation(CoV),dependent silent spaces(DSS),and non-dependent silent spaces(NSS)were recorded.Blood gas analysis was performed at T_(1) to record pH value,PaO_(2) and PaCO_(2).Hypoxemia was recorded during ventilation.Results Compared with control group,MV,Pmean and area percentage of NSS were significantly increased and area percentage of DSS was decreased at T_(1,2),P_(ET)CO_(2) was decreased and SpO_(2) and area percentage of CoV were increased at T_(1),pH value and PaO_(2) were increased,and PaCO_(2) and the incidence of hypoxemia were decreased in test group(P<0.05).Conclusion Combination of laryngeal mask airway and a thin tube at the distal end of airway stenosis for constant flow oxygen supply can improve the ventilation efficacy by increasing the oxygen concentration at the distal end of the stenosis and by reopening the collapsed lung tissue at t

关 键 词：喉面罩 气管狭窄 支气管镜检查 呼吸 人工 氧吸入疗法 

分 类 号：R614[医药卫生—麻醉学]