硬质支气管镜与插管型喉罩通气模式在老年中央型支气管肺癌患者中的应用  

Application of rigid bronchoscope and intubated laryngeal mask in elderly patients with central bronchogenic carcinoma

作　　者：吴瑶[1] 顾伟[1] 吴浩[1] 孙玉娥[1] WuYao;GuWei;WuHao;SunYue(Department of Anesthesia and Surgery,the Affiliated Drum Tower Hospital of Nanjing University Medical School,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院麻醉手术科,南京210008

出　　处：《国际麻醉学与复苏杂志》2024年第2期155-159,共5页International Journal of Anesthesiology and Resuscitation

基　　金：国家自然科学基金(82071229,81870871);南京市卫生科技发展专项基金(YKK22089);南京大学中国医院改革发展研究院课题,南京鼓楼医院医学发展医疗救助基金会资助项目(NDYG202058);南京鼓楼医院临床青年培育项目(2023-LCYJ-PY-07)。

摘　　要：目的探讨基于呼吸内镜介入治疗评估硬质支气管镜与插管型喉罩通气模式在老年中央型支气管肺癌患者中的应用效果。方法回顾性分析行呼吸内镜介入治疗的老年中央型支气管肺癌患者86例,按通气模式将患者分为硬质支气管镜组(Y组,44例)和插管型喉罩组(L组,42例)。记录两组患者入室时(T_(0))、通气管道置入时(T_(1))、内镜介入治疗进镜手术开始时(T_(2))、治疗结束退镜时(T3)、拔除通气管道时(T_(4))的脉搏血氧饱和度(SpO_(2))、心率、收缩压(SBP)、平均动脉压(MAP),并计算动脉收缩压变异度(SPV)。记录两组患者苏醒时间、通气管道拔除时间、麻黄碱使用比例及总量、需手控辅助通气的次数、口腔咽喉部损伤发生率、操作医师满意度、患者满意度。结果与T0时比较:L组患者T1~T4时SPV降低(均P<0.05);Y组患者T_(1)、T_(2)、T_(4)时SBP、心率、MAP升高(均P<0.05),T_(3)、T_(4)时SPV降低(均P<0.05)。L组T_(3)、T_(4)时SPV低于Y组(均P<0.05)。两组患者各时点SpO_(2)差异无统计学意义(均P>0.05)。与Y组比较:L组患者苏醒时间、通气管道拔除时间较短(均P<0.05),麻黄碱使用比例及总量、口腔咽喉部损伤发生率、需手控辅助通气的次数较低(均P<0.05),患者满意度、操作医师满意度较高(均P<0.05)。结论插管型喉罩通气模式及硬质支气管镜在老年中央型支气管肺癌呼吸内镜介入治疗中各有利弊,要结合患者的心肺功能及肿瘤的大小、位置,与呼吸内科医师讨论后决定更适合老年患者的通气策略。Objective To evaluate the application of rigid bronchoscope and intubated laryngeal mask airway ventilation in elderly patients with central bronchogenic carcinoma based on respiratory endoscopic intervention.Methods A total of 86 elderly patients with central bronchogenic carcinoma who underwent respiratory endoscopic intervention were selected and their clinical data were retrospectively analyzed.According to their ventilation modes,the patients were divided into two groups:a rigid bronchoscope group(group Y,n=44)and an intubated laryngeal mask group(group L,n=42).Their pulse oxygen saturation(SpO_(2)),heart rate,systolic blood pressure(SBP)and mean arterial pressure(MAP)when the patients entered into the room(T_(0)),at the insertion of the ventilation tube(T_(1)),at the beginning of endoscopic intervention(T_(2)),at the withdrawal of the tube(T_(3)),and at the removal of the ventilation tube(T_(4))were recorded,and the arterial systolic pressure variation(SPV)was calculated.The time to postoperative recovery,the time to withdraw the ventilation tube,the percentage and total dosage of ephedrine,the number of manually assisted ventilation,the incidences of oral and throat injury,as well as the satisfaction of endoscopic interventional surgeons and patients toward endoscopic intervention were recorded.Results Compared with those at T_(0),patients in group L showed decreases in SPV at T_(1)‒T_(4)(all P<0.05),while group Y presented increases in SBP,heart rate and MAP at T_(1),T_(2) and T_(4)(all P<0.05),as well as decreases in SPV at T3 and T4(all P<0.05).SPV in group L was lower than that in group Y at T_(3) and T_(4)(all P<0.05).No statistical difference was found as to SpO_(2) at each time point between the two groups(all P>0.05).Compared with group Y,group L presented decreases in the recovery time,the time to withdraw the tube,the percentage and total dosage of ephedrine,the incidence of oral and throat injury,and the number of manually assisted ventilation(all P<0.05),as well as increases in the satisfacti

关 键 词：插管型喉罩 硬质支气管镜 中央型肺癌 内镜介入治疗 

分 类 号：R734.2[医药卫生—肿瘤]