经鼻湿化快速充气交换通气技术在全身麻醉下硬质食管镜异物取出术中的应用效果  

Evaluation of transnasal humidified rapid‑insufflation ventilatory exchange technology in rigid esophagoscopy for foreign body removal under general anesthesia

作　　者：张丛雅 雷桂玉 包音[1] 王古岩 Zhang Congya;Lei Guiyu;Bao Yin;Wang Guyan(Department of Anesthesiology,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京同仁医院麻醉科,北京100730

出　　处：《中华医学杂志》2025年第10期739-744,共6页National Medical Journal of China

基　　金：北京市医院管理中心“登峰”计划(DFL20220203)。

摘　　要：目的分析经鼻湿化快速充气交换通气(THRIVE)在全身麻醉下硬质食管镜异物取出术中应用效果。方法前瞻性纳入2022年9—12月于北京同仁医院行全身麻醉下硬质食管镜异物取出术的患者。入手术室后经鼻高流量吸氧5 min,吸入氧温度37℃,氧浓度100%,氧流量为30 L/min。麻醉诱导后,吸氧流量调至60~80 L/min,直至患者苏醒撤机。主要观察指标为THRIVE成功率[成功定义为麻醉全过程脉搏血氧饱和度(SpO2)≥95%];安全性指标为与THRIVE相关的并发症发生率。记录手术时间,呼吸暂停时间,麻醉时间,患者入手术室时(T0)、高流量吸氧5 min后(T1)、麻醉诱导后(T2)、置入食管镜时(T3)、退食管镜术毕(T4)、苏醒时(T5)、出手术室时(T6)各时间点的心率,平均动脉压(MAP),SpO2。结果纳入50例患者,男17例,女33例,年龄(54.0±20.5)岁。THRIVE成功率为86%(43/50)。共有7例患者需气道干预,其中6例行面罩加压通气,1例行气管插管;其中3例发生在手术结束前,需中断手术行气道干预。未发生与THRIVE相关并发症。T6时心率高于T2[(86±12)比(79±15)次/min,P<0.001]。T2时MAP低于T0、T1[分别为(90.4±13.3)、(105.5±14.2)和(102.0±13.7)mmHg(1 mmHg=0.133 kPa),均P<0.001]。T4、T5时MAP均低于T2[分别为(84.8±15.0)、(82.9±14.5)和(90.4±13.3)mmHg,均P<0.001]。在手术过程中和术后恢复室监测期间,未发生心血管以及呼吸系统不良事件。结论THRIVE可安全、有效地应用于全身麻醉下硬质食管镜异物取出术,提供有效氧合,维持循环稳定。Objective To explore the efficacy of transnasal humidified rapid‑insufflation ventilatory exchange(THRIVE)technology in rigid esophagoscopy for foreign body removal under general anesthesia.Methods Patients who underwent rigid esophagoscopy for foreign body removal under general anesthesia from September to December 2022 at Beijing Tongren Hospital were prospectively included.After entering the operating room,all patients received high‑flow oxygen for 5 minutes,with an inhaled temperature of 37℃,an oxygen concentration of 100%,and an oxygen flow rate of 30 L/min.After anesthesia induction,the oxygen flow rate was adjusted to 60‑80 L/min until the patients awoke.The primary outcome was the success rate of THRIVE defined as percutaneous oxygen saturation(SpO2)≥95%throughout anesthesia,while the safety outcome was the incidence of complications associated with THRIVE.The operation time,apnea time,anesthesia duration,heart rate,mean arterial pressure,and SpO2 were recorded at the following time points,such as entering the operating room(T0),after 5 minutes of high‑flow oxygenation(T1),post‑anesthesia induction(T2),during esophagoscope insertion(T3),at the end of the procedure upon esophagoscope withdraw(T4),upon awakening(T5),and upon exiting the operating room(T6).Results Fifty patients(17 males and 33 females)were enrolled,with an age of(54.0±20.5).The success rate of THRIVE technology was 86%(43/50).A total of 7 patients required airway intervention,among which 6 patients underwent mask compression ventilation and 1 patient underwent endotracheal intubation intraoperatively.Three cases occurred before the end of esophagoscopy and required interruption of esophagoscopy for airway intervention.No complications related to THRIVE technology were observed.The heart rate of all patients was(86±12)beats/min at T6,which was significantly higher than that of(79±15)beats/min at T2(P<0.001).The mean arterial pressure(MAP)was(90.4±13.3)mmHg(1 mmHg=0.133 kPa)at T2,which were significantly lower than that of(1

关 键 词：麻醉 全身 食管镜 窒息氧合 经鼻湿化快速充气交换通气 食管异物取出术 

分 类 号：R47[医药卫生—护理学]