反比通气应用于硬质气管镜诊疗的效果观察

Observation on the effect of inverse ratio ventilation in rigid tracheoscopy

摘要:

目的 观察反比通气（IRV）应用于硬质气管镜诊疗的效果。方法 选择接受无痛硬质气管镜诊疗的患者50例，随机分为A组（IRV组）和B组（对照组），均行常频喷射通气，A组吸呼比2∶1，B组吸呼比1∶2，余呼吸参数两组设置相同（喷射氧浓度100%，喷射频率20次/min，驱动压0.05～0.15 MPa）。比较T₀（麻醉前）、T₁（操作开始后10 min）、T₂（操作开始后20 min）和T₃（操作开始后30 min）时点患者的动脉血气［包括：酸碱度（pH）、动脉血氧分压（PaO₂）、动脉血二氧化碳分压（PaCO₂）］、心率（HR）、平均动脉压（MAP）和达到理想呼吸幅度时的呼吸机驱动压，以及经皮动脉血氧饱和度（SpO₂）< 95%、术中低氧血症（SpO₂ < 90%）和循环不稳定事件的发生率。结果 A组呼吸机驱动压低于B组，SpO₂ < 95%发生率低于B组，两组患者T₁、T₂和T₃时点的PaO₂高于T₀时点，两组患者T₂和T₃时点的HR和MAP低于T₀时点，差异均有统计学意义（P < 0.05）；两组间各时点HR、MAP、PaO₂、pH和PaCO₂比较，差异均无统计学意义（P > 0.05）。结论 IRV应用于硬质气管镜诊疗，可有效降低驱动压，减少气压伤发生的风险，同时可改善氧合，且不会造成CO₂蓄积，患者血流动力学稳定，在临床上是安全、可行的。

Abstract:

Objective To observe the effect of inverse ratio ventilation (IRV) in the diagnosis and treatment of rigid tracheoscopy.Methods 50 patients with painless rigid tracheoscopy were randomly divided into two groups. The ratio of I/E was 2∶1 in group A and 1∶2 in group B. The other respiratory parameters were set the same in the two groups (100% injection oxygen concentration, 20 time/min, driving pressure 0.05 ~ 0.15 MPa). The arterial blood gas [potential of hydrogen (pH), arterial partial pressure of oxygen (PaO₂), partial pressure of carbon dioxide in arterial blood (PaCO₂)], heart rate (HR) and mean arterial pressure (MAP) were compared at T₀ (before anesthesia), T₁ (10 min after the beginning of operation), T₂ (20 min after the beginning of operation) and T₃ (30 min after the beginning of operation). Ventilator driving pressure when the ideal breathing range was reached, the incidence rate of patients with percutaneous arterial oxygen saturation (SpO₂) < 95% and intraoperative hypoxemia (SpO₂ < 90%) and circulatory instability events were compared.Results The ventilator driving pressure of group A was lower than that of group B, patients with SpO₂ < 95% was less than that in group B, the PaO₂ of the two groups at T₁, T₂ and T₃ were higher than those at T₀, the HR and MAP of the two groups at T₂ and T₃ were lower than those at T₀, the differences were statistically significant (P < 0.05); No significant differences were found in HR, MAP, PaO₂, pH or PaCO₂ at each time point between the two groups (P > 0.05).Conclusion The application of IRV in rigid tracheoscopy can effectively reduce the driving pressure, and reduce the risk of barotrauma, improve oxygenation, does not cause CO₂ accumulation, and is hemodynamic stability, which is safe and feasible in clinical practice.