内镜面罩与喉罩无创辅助通气在无痛支气管镜诊疗中的应用效果比较  

Comparison of noninvasive ventilation with endoscopic mask and laryngeal mask in disease diagnosis and treatment by indolent fiberoptic bronchoscopy

作　　者：梁宇峰[1] 王超 黄献锋 朱琳玲[1] 杨芳琼 Liang Yufeng;Wang Chao;Huang Xianfeng(Department of Respiratory and Critical Care Medicine,Yulin First People's Hospital,Yulin 534000,China)

机构地区：[1]玉林市第一人民医院呼吸与危重症医学科,广西玉林534000

出　　处：《中华临床医师杂志（电子版）》2022年第7期652-656,共5页Chinese Journal of Clinicians(Electronic Edition)

基　　金：玉林市科学研究与技术开发计划项目(玉林科20204407)。

摘　　要：目的探讨内镜面罩与喉罩无创辅助通气在无痛支气管镜诊疗中的应用效果比较。方法选择2020年10月至2021年5月于玉林市第一人民医院呼吸与危重症医学科行静脉麻醉下纤维支气管镜诊疗的患者,共100例。将受试者随机分为2组:内镜检查面罩通气组(M组)予以内镜面罩接无创呼吸机辅助通气,每组50例;喉罩通气组(L组)予以置入喉罩接无创呼吸机辅助通气,每组50例。所有患者均予以静脉麻醉:丙泊酚联合舒芬太尼。记录所有患者支气管镜检查的麻醉时间和检查时间;记录麻醉前(t_(0))、麻醉诱导后2 min(t_(1))、气管镜越过隆突后2 min(t_(2))及退镜后(t_(3))各时间点受试者的循环相关指标,包括收缩压(SBP)、心率(HR)及呼吸情况:指脉搏血氧饱和度(SpO_(2))、自主呼吸频率(RR);评估并记录患者麻醉满意度及操作医生的满意度。记录不良反应情况:发生低氧血症(SpO_(2)<90%)=的患者例数,检查期间体动、咳嗽、喉痉挛及咽喉痛。结果2组患者支气管镜检查的麻醉时间和检查时间比较,差异无统计学意义(P>0.05)。2组患者4个时点的SBP、HR、SpO_(2)、RR比较,差异均无统计学意义(P>0.05)。L组患者麻醉满意度及操作医生满意度评分均显著高于M组(P<0.05)。与M组相比,L组发生低氧血症的患者例数显著减少(P<0.05)。M组检查期间体动、呛咳的发生率显著高于L组(P<0.05);2组喉痉挛及咽痛的发生率比较差异无统计学意义(P>0.05)。此外,在术前肺功能正常或轻中度下降的患者中,L组、M组患者低氧血症发生率比较,差异无统计学意义(P>0.05);而在术前重度及极重度肺功能损害的患者,与L组相比,M组低氧血症的发生率显著升高(P<0.05)。结论在肺功能正常或轻中度下降的患者,面罩及喉罩接无创呼吸机辅助通气均能达到良好的效果,考虑耗占比,优先推荐内镜面罩;在重度及极重度肺功能损害的患者,因喉罩通气效果Objective To investigate the effect of noninvasive ventilation with endoscopic mask and laryngeal mask in disease diagnosis and treatment by indolent fiberoptic bronchoscopy.Methods One hundred patients scheduled for indolent fiberoptic bronchoscopy between October 2020 and May 2021 at our hospital were randomly divided into two groups:Mask group(group M),laryngeal mask group(group L),with 50 patients in each group.Patients in group M were ventilated with endoscopic mask,and patients in group L were ventilated with laryngeal mask.Patients in both groups received propofol combined with intravenous anesthesia.The anesthesia time and operation time were recorded.Systolic blood pressure(SBP),heart rate(HR),SpO_(2),and respiratory rate(RR)were recorded upon entering the operating room(t_(0)),2 min after anesthesia induction(t_(1)),2 min after the bronchoscope enters the trachea(t_(2)),and after exiting the tracheoscope(t_(3)).The patient's satisfaction with anesthesia and the doctor's satisfaction were assessed and recorded.The number of patients with hypoxemia(SpO_(2)<90%),and the adverse effects including body movement,cough,laryngeal spasm,and sore throat after examination were also recorded.Results Anesthesia time and operation time did not differ significantly between the two groups(P>0.05).SBP,HR,SpO_(2),and RR did not differ between the two groups at each time point(P>0.05).Compared with group M,the patient's satisfaction with anesthesia and doctor's satisfaction were significantly higher in group L(P<0.05).The number of patients with hypoxemia in group L was significantly lower than that in group M(P<0.05).Compared with group L,the incidence of body movement and cough was significantly higher in group M(P<0.05),though the incidence of laryngeal spasm and sore throat did not differ significantly between the two groups(P>0.05).Among patients with normal or mild to moderate preoperative lung dysfunction,there was no statistical difference in the incidence of hypoxemia between the two groups(P>0.05).Compared with

关 键 词：内镜面罩 喉罩 支气管镜诊疗 静脉麻醉 

分 类 号：R459.7[医药卫生—急诊医学]