反比通气应用于硬质气管镜诊疗的效果观察  

Observation on the effect of inverse ratio ventilation in rigid tracheoscopy

作　　者：吕静 彭建良 杨娜瑜 LüJing;Peng Jianliang;Yang Nayu(Department of Anesthesiology,the Second Affiliated Hospital of Xiamen Medical College,Xiamen,Fujian 361021,China)

机构地区：[1]厦门医学院附属第二医院麻醉科,福建厦门361021

出　　处：《中国内镜杂志》2023年第8期7-12,共6页China Journal of Endoscopy

基　　金：福建省教育厅项目(No:JAT190841)。

摘　　要：目的观察反比通气(IRV)应用于硬质气管镜诊疗的效果。方法选择接受无痛硬质气管镜诊疗的患者50例,随机分为A组(IRV组)和B组(对照组),均行常频喷射通气,A组吸呼比2∶1,B组吸呼比1∶2,余呼吸参数两组设置相同(喷射氧浓度100%,喷射频率20次/min,驱动压0.05~0.15 MPa)。比较T_(0)(麻醉前)、T_(1)(操作开始后10 min)、T_(2)(操作开始后20 min)和T_(3)(操作开始后30 min)时点患者的动脉血气[包括:酸碱度(pH)、动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))]、心率(HR)、平均动脉压(MAP)和达到理想呼吸幅度时的呼吸机驱动压,以及经皮动脉血氧饱和度(SpO_(2))<95%、术中低氧血症(SpO_(2)<90%)和循环不稳定事件的发生率。结果A组呼吸机驱动压低于B组,SpO_(2)<95%发生率低于B组,两组患者T_(1)、T_(2)和T_(3)时点的PaO_(2)高于T_(0)时点,两组患者T_(2)和T_(3)时点的HR和MAP低于T_(0)时点,差异均有统计学意义(P<0.05);两组间各时点HR、MAP、PaO_(2)、pH和PaCO_(2)比较,差异均无统计学意义(P>0.05)。结论IRV应用于硬质气管镜诊疗,可有效降低驱动压,减少气压伤发生的风险,同时可改善氧合,且不会造成CO_(2)蓄积,患者血流动力学稳定,在临床上是安全、可行的。Objective To observe the effect of inverse ratio ventilation(IRV)in the diagnosis and treatment of rigid tracheoscopy.Methods 50 patients with painless rigid tracheoscopy were randomly divided into two groups.The ratio of I/E was 2∶1 in group A and 1∶2 in group B.The other respiratory parameters were set the same in the two groups(100%injection oxygen concentration,20 time/min,driving pressure 0.05~0.15 MPa).The arterial blood gas[potential of hydrogen(pH),arterial partial pressure of oxygen(PaO_(2)),partial pressure of carbon dioxide in arterial blood(PaCO_(2))],heart rate(HR)and mean arterial pressure(MAP)were compared at T_(0)(before anesthesia),T_(1)(10 min after the beginning of operation),T_(2)(20 min after the beginning of operation)and T_(3)(30 min after the beginning of operation).Ventilator driving pressure when the ideal breathing range was reached,the incidence rate of patients with percutaneous arterial oxygen saturation(SpO_(2))<95%and intraoperative hypoxemia(SpO_(2)<90%)and circulatory instability events were compared.Results The ventilator driving pressure of group A was lower than that of group B,patients with SpO_(2)<95%was less than that in group B,the PaO_(2)of the two groups at T_(1),T_(2)and T_(3)were higher than those at T_(0),the HR and MAP of the two groups at T_(2)and T_(3)were lower than those at T_(0),the differences were statistically significant(P<0.05);No significant differences were found in HR,MAP,PaO_(2),pH or PaCO_(2)at each time point between the two groups(P>0.05).Conclusion The application of IRV in rigid tracheoscopy can effectively reduce the driving pressure,and reduce the risk of barotrauma,improve oxygenation,does not cause CO_(2)accumulation,and is hemodynamic stability,which is safe and feasible in clinical practice.

关 键 词：反比通气 喷射通气 硬质气管镜 诊疗 应用 

分 类 号：R614[医药卫生—麻醉学]