魏式鼻咽通气道联合声门上喷射供氧和通气技术在ERCP手术中的应用  

The application of Wei style nasopharyngeal airway combined with supraglottic jet oxygen supply and ventilation technique in ERCP

作　　者：付紫辉 蒋明[1] 王尔华[1] 张晓坤[1] 肖江强[2] 张以洋[2] FU Zi-hui;JIANG Ming;WANG Er-hua;ZHANG Xiao-kun;XIAO Jiang-qiang;ZHANG Yi-yang(Department of Anesthesiology,Gulou Hospital,Nanjing University Medical College,Nanjing 210008,Jiangsu,China)

机构地区：[1]南京大学医学院附属鼓楼医院麻醉科,江苏南京210008 [2]南京大学医学院附属鼓楼医院消化内科,江苏南京210008

出　　处：《广东医学》2023年第4期448-451,共4页Guangdong Medical Journal

基　　金：国家自然科学基金资助项目(82100652)。

摘　　要：目的探讨魏式鼻咽通气道联合声门上喷射供氧和通气技术在经内镜逆行胰胆管造影术(ER-CP)中的安全性及可行性.方法把行ERCP手术患者100例随机分为声门上喷射组和鼻咽通气道给氧组,每组50例,同时分别于诱导前(T0)、诱导后(T1)、进镜入咽部(T2)、置入十二指大乳头处(T3)和退镜(T4)时记录患者心率(HR)、平均动脉压(MAP)和脉搏血氧饱和度(SpO_(2))、并在各时间点抽取桡动脉血进行血气分析.统计每组患者发生低氧血症情况和纠正低氧血症的方法以及其他不良事件等.结果鼻咽通气道给氧组出现亚临床低氧血症(90%≤SpO_(2)<95%)8例,轻度低氧血症(75%≤SpO_(2)<90%)5例,严重低氧血症(SpO_(2)<75%或SpO_(2)<90%,持续时间>60 s)2例,其中10例是需要调节氧流量或托下颌,5例通过面罩加压给氧,1例行气管插管纠正低氧血症,而声门上喷射组没有出现低氧血症.T2、T3和T4时间点声门上喷射组PaO_(2)明显高于鼻咽通气道给氧组、声门上喷射组二氧化碳分压(PaCO_(2))在T2、T3和T4时间点显著低于鼻咽通气道给氧组.在鼻出血、口干、咽痛方面声门上喷射组高于鼻咽通气道给氧组,在胃胀气、体动致手术暂停方面鼻咽通气道给氧组高于声门上喷射组.结论魏式鼻咽通气道联合声门上喷射供氧和通气技术在ER-CP手术中能够明显降低低氧血症的发生率,是安全可靠的.Objective To investigate the safety and feasibility of supraglottic oxygen injection and ventilation combined with Wei style nasopharyngeal airway on ERCP.Methods One hundred patients received ERCP were randomly divided into supraglottic injection group and nasopharyngeal airway oxygenation group(n=50).Heart rate(HR),mean arterial pressure(MAP),and pulse oxygen saturation(SpO_(2))were recorded during ERCP;and the radial artery blood was sampled for blood gas analysis.The occurrence of hypoxemia,the methods of correcting hypoxemia and other adverse events in each group were recorded.Results There were 12 cases of subclinical hypoxemia(90%≤SpO_(2)<95%),5 cases of mild hypoxemia(75%≤SpO_(2)<90%)and 2 cases of severe hypoxemia(SpO_(2)<75%or SpO_(2)<90%duration>60s)in the nasopharyngeal airway oxygenation group.Among them,10 cases needed to adjust the oxygen flow or mandible support;5 cases were given with oxygen under pressure through a mask;1 case was treated with endotracheal intubation to correct hypoxemia;and there was no hypoxemia reported in the supraglottic injection group.At T2,T3 and T4,PaO_(2) in supraglottic injection group was significantly higher than that in nasopharynx airway oxygenation group,and PaCO_(2) in supraglottic injection group was significantly lower than that in nasopharynx airway oxygenation group.In terms of epistaxis,dry mouth and pharyngeal pain,the supraglottic injection group was higher than the nasopharyngeal airway oxygen group,and the nasopharyngeal airway oxygen group was higher than the supraglottic injection group in terms of gastrointestinal flatulence and body movement induced surgical stop.Conclusion The combination of supraglottic oxygen injection and ventilation technology with Wei style nasopharyngeal airway can significantly reduce the incidence of hypoxemia during ERCP,which is safe and reliable.

关 键 词：声门上喷射供氧和通气 魏氏鼻咽通气道 经内镜逆行胰胆管造影术 

分 类 号：R614.2[医药卫生—麻醉学] R614.24[医药卫生—外科学]