全凭静脉麻醉下叠加式高频喷射通气在硬质气管镜诊疗中的应用

Application of superimposed high-frequency jet ventilation under total intravenous anesthesia in rigid bronchoscopy

摘要:

目的 探讨全凭静脉麻醉下叠加式高频喷射通气（SHFJV）与高频喷射通气（HFJV）联合间断手控通气两种通气方式在硬质气管镜诊疗中的应用效果。方法 回顾性分析2016年9月－2020年12月80例该院行硬质气管镜诊疗患者的临床资料，根据不同通气方式分为SHFJV与HFJV两组。比较两组患者入室时（T₁）、插管时（T₂）、机械通气10 min（T₃）、机械通气20 min（T₄）、术毕（T₅）的心率（HR）和平均动脉压（MAP）以及T₁、T₃、T₄、T₅时点的动脉血气分析结果［酸碱度（pH）、氧合指数（PaO₂/FiO₂）、动脉血二氧化碳分压（PaCO₂）］和术中不良事件（血流动力学不稳事件、低氧血症、高碳酸血症、恶性心律失常、气道痉挛、是否中止手术）。结果 硬质气管镜诊疗期间，两组患者T₂时点HR、MAP与T₁时点比较，差异无统计学意义（P > 0.05），T₃、T₄和T₅时点MAP较T₁时点明显下降（P < 0.05），T₃和T₄时点pH和PaO₂/FiO₂较T₁时点明显下降，PaCO₂较T₁时点明显上升（P < 0.05）；组间比较，SHFJV组T₃、T₄和T₅时点pH和PaO₂/FiO₂明显较高，PaCO₂明显较低（P < 0.05），HFJV组术中血流动力学不稳事件及高碳酸血症发生率较高（P < 0.05）。结论 全凭静脉麻醉下SHFJV在硬质气管镜诊疗中的应用安全、可行，值得临床推广使用。

Abstract:

Objective To investigate the application effects of superimposed high-frequency jet ventilation (SHFJV) and high frequency jet ventilation (HFJV) combined with intermittent manual ventilation under total intravenous anesthesia in rigid bronchoscopy.Methods The clinical data of 80 patients who received rigid tracheoscopy from September 2016 to December 2020 were retrospectively analyzed, and they were divided into SHFJV and HFJV groups according to different ventilation modes. The heart rate (HR), mean arterial blood pressure (MAP) and arterial blood gas analysis results [pH, partial pressure of oxygen in arterial blood/fractional concentration of inspiratory oxygen (PaO₂ / FiO₂), partial pressure of carbon dioxide in arterial blood (PaCO₂)] at the corresponding time points of admission (T₁), intubation (T₂), and mechanical ventilation for 10 min (T₃), mechanical ventilation for 20 min (T₄), after operation (T₅), and intraoperative adverse events (hemodynamic instability events, hypoxemia, hypercapnia, malignant arrhythmias, airway spasm, whether to abort surgery operation termination) were compared between the two groups.Results During the diagnosis and treatment of rigid trachea, compared with T₁, there were no significant difference in HR and MAP at T₂ in each group (P > 0.05), and MAP decreased at T₃, T₄ and T₅ compared with T₁ (P < 0.05), the pH and PaO₂ / FiO₂ significant decreased and PaCO₂ increased at T₃, T₄ compared with T₁ (P < 0.05); The pH and PaO₂ / FiO₂ in SHFJV group were significantly higher and the PaCO₂ in SHFJV group was significantly lower than those in HFJV group at T₃, T₄, T₅ (P < 0.05); The incidence of intraoperative hemodynamic instability and hypercapnia were higher in HFJV group (P < 0.05).Conclusion The application of SHFJV under total intravenous anesthesia in rigid bronchoscopy is a relatively safe and feasible anesthesia management method, which is worthy of clinical recommendation.