深度肌松对硬质支气管镜治疗术中常频喷射通气效果的影响  

Effect of deep muscle relaxation on oxygenation of jet ventilation during rigid bronchoscopy procedures

作　　者：任秋生 王艳芳[2] 黄丽君 顾霄 王华英 彭卫东 REN Qiusheng;WANG Yanfang;HUANG Lijun;GU Xiao;WANG Huaying;PENG Weidong(Department of Anesthesiology,Hangzhou Ninth People's Hospital,Hangzhou,Zhejiang 311225,China)

机构地区：[1]杭州市第九人民医院麻醉科,浙江杭州311225 [2]宁波大学附属人民医院危重医学科,浙江宁波315040 [3]宁波大学附属人民医院麻醉科 [4]宁波大学附属人民医院呼吸科

出　　处：《中华全科医学》2023年第10期1679-1682,1766,共5页Chinese Journal of General Practice

基　　金：浙江省医药卫生科技计划项目(2021KY332)。

摘　　要：目的 硬质支气管镜手术中喷射通气最佳条件仍未明确,本研究探讨硬质支气管镜术中深度肌松对喷射通气氧合效果的影响。方法 选择2021年1月—2022年12月宁波大学附属人民医院择期行全身麻醉下经硬质支气管镜中央气道病变治疗患者68例,采用随机数字表法分为2组:深度肌松组(D组,34例)和中度肌松组(M组,34例)。患者全麻诱导后插入硬质支气管镜行喷射通气,M组采用4个成串刺激(TOF)测定肌松深度,维持TOF计数为1~2;D组采用强直刺激后单刺激肌颤搐计数(PTC)测定肌松深度,维持PTC在1~2。术毕阿托品、新斯的明拮抗残余肌松。结果 2组患者整体手术时间、手术时间比较,差异无统计学意义(均P>0.05);D组麻醉时间小于M组(P<0.01);D组苏醒时间、拔管时间、肌松剂用量大于M组(均P<0.05);D组患者术中缺氧事件[(2.7±0.6)次/人]、采取缺氧干预措施(27/33)、手术暂停时间[(7.6±3.5)min]均小于M组[(8.8±2.6)次/人、33/33、(19.3±5.6)min],且术者满意度评分[(9.4±0.5)分]高于M组[(6.2±1.5)分,P<0.05];D组动脉血氧分压在喷射通气15、30 min时间点高于M组(均P<0.05);D组术后咽喉疼痛例数(18/33)少于M组(26/33,P=0.037)。结论 硬质支气管镜治疗术中应用深度肌松可以改善喷射通气的氧合效果,减少缺氧事件、手术暂停时间及麻醉时间,提高术者满意度,对整体手术时间无影响。Objective The optimal condition of jet ventilation during rigid bronchoscopy is still unclear.This study explores the effect of deep muscle relaxation during rigid bronchoscopy on the oxygenation effect of jet ventilation.Methods Sixty-eight patients who received selective treatment for central airway lesions under general anesthesia by rigid bronchoscopy from January 2021 to December 2022 in the Affiliated People's Hospital of Ningbo University were divided into deep muscle relaxation group(group D,n=34)and moderate muscle relaxation group(group M,n=34)by random number table method.After induction of general anesthesia,the patients were inserted rigid bronchoscopy for jet ventilation.Train of four(TOF)stimulation was used to measure the depth of muscle relaxation in group M,and the TOF count was maintained at 1-2.In Group D,the depth of muscle relaxation was measured by post tetanic count(PTC),and the PTC was maintained at 1-2.After operation,atropine and neostigmine antagonized residual muscle relaxation.Results There were no significant differences in the overall operation time and operation time between the two groups(all P>0.05).The anesthesia time in group D was shorter than that in group M(P<0.01).The recovery time,extubation time and muscle relaxant dosage in group D were longer than those in group M(all P<0.05).The intraoperative hypoxic events[(2.7±0.6)times/person],the use of hypoxic intervention measures(27/33)and the operation suspension time[(7.6±3.5)min]in group D were lower than those in group M[(8.8±2.6)times/person,33/33,(19.3±5.6)min],and the surgeon satisfaction score in group D[(9.4±0.5)points]was higher than that in group M[(6.2±1.5)points,P<0.05].The arterial oxygen partial pressure in group D was higher than that in group M at 15 and 30 min of jet ventilation(all P<0.05).The number of cases with postoperative sore throat in group D(18/33)was lower than that in group M(26/33,P=0.037).Conclusion The application of deep muscle relaxation in rigid bronchoscopy procedures can improve the

关 键 词：深度肌松 硬质支气管镜 喷射通气 氧合 

分 类 号：R614[医药卫生—麻醉学] R768.1[医药卫生—外科学]