两种不同通气装置在神经外科术中唤醒手术中的应用对比  

Comparison of two different ventilation devices in awake craniotomy

作　　者：徐丽华 龙伟 郑思媛[1] 谢科宇[1] 刘少星[1] 苟丹 XU Lihua;LONG Wei;ZHENG Siyuan;XIE Keyu;LIU Shaoxing;GOU Dan(Chengdu Second People’s Hospital,Chengdu 610000,China;Sichuan Provincial People’s Hospital,Chengdu 610072,China)

机构地区：[1]成都市第二人民医院,四川成都610000 [2]四川省人民医院,四川成都610072

出　　处：《中国实用神经疾病杂志》2024年第6期753-757,共5页Chinese Journal of Practical Nervous Diseases

基　　金：四川省卫生健康委员会医学科技项目(编号:21PJ141)。

摘　　要：目的对比喉罩与高流量鼻导管(HFNC)两种不同通气装置在清醒开颅手术中的安全性和有效性。方法60例接受清醒开颅手术的患者被随机分配使用喉罩(L组)和HFNC(H组)进行麻醉气道管理。收集和分析不同时间点(T0:麻醉诱导前;T1:麻醉诱导后15 min;T2:唤醒阶段;T3:再次麻醉后15 min)术中血气分析数据、大脑松弛评分(BRS)、胃窦容量和不良事件。结果T2时H组血氧饱和度高于L组,动脉血二氧化碳分压低于L组(P<0.05),其余时间点2组血氧饱和度和二氧化碳分压无统计学差异(P>0.05)。L组的氧合指数在T0、T1、T3均显著高于H组,但在T2却显著低于H组(P<0.05)。2组患者在硬脑膜悬吊和T2的BRS评分及术前、术后的胃窦容量均无统计学差异(P>0.05)。在通气工具插入相关并发症方面,L组的咽痛率和术后咳嗽发生率显著高于H组(P<0.05),H组鼻塞发生率高于L组(P<0.05)。术中不良反应包括低氧血症、癫痫发作、体动、口干和寒战2组均无统计学差异(P>0.05)。结论HFNC应用于清醒开颅手术能达到喉罩的氧合效果,且在唤醒阶段更具优势,不会造成气压伤和颅内压增高的情况。Objective To compare the safety and effectiveness of two different ventilation deviceslaryngeal mask and high-flow nasal cannula(high-flow nasal cannula,HFNC)during awake craniotomy.Methods Sixty patients undergoing awake craniotomy were randomly assigned to use laryngeal mask(group L)or HFNC(group H)for anesthesia airway management.The intraoperative blood gas analysis,brain relaxation score(BRS),gastric antrum volume and adverse events data at different time points(T0:before induction of anesthesia;T1:15 minutes after induction of anesthesia;T2:wake-up phase;T3:15 minutes after re-anesthesia)were collected and analyzed.Results During the patient’s wake-up phase(T2),the blood oxygen saturation of group H was higher than that of group L,while the partial pressure of carbon dioxide in arterial blood was lower than that of group L(P<0.05).There was no statistical difference(P>0.05).The oxygenation index of group L was significantly higher than that of group H at T0,T1,and T3,but it was significantly lower than that of group H during the wake-up phase(P<0.05).There was no significant difference in the BRS scores in the dural suspension and wake-up stages,as well as the gastric antrum volume before and after operation between the two groups(P>0.05).In terms of complications related to ventilation tool insertion,the incidence of sore throat and postoperative cough in group L was significantly higher than that in group H(P<0.05),and the incidence of nasal congestion in group H was higher than that in group L(P<0.05).There was no significant difference in intraoperative adverse reactions between the two groups in terms of hypoxemia,seizures,body movement,dry mouth and chills(P>0.05).Conclusion The application of HFNC in awake craniotomy can achieve the oxygenation effect of laryngeal mask,and it has more advantages in the awakening stage.At the same time,it does not cause barotrauma and increased intracranial pressure.

关 键 词：清醒开颅手术 神经外科手术 术中唤醒 喉罩 经鼻高流量 

分 类 号：R651.11[医药卫生—外科学]