国际麻醉学与复苏杂志   2017, Issue (7): 8-8
    
声门上喷射通气在无痛纤维支气管镜检查中的应用
吴志云, 查本俊, 胡吉, 谢平, 熊华平1()
1.福建省泉州市解放军第910医院
Clinical application of supraglottic jet ventilation during painless fiberbronchoscopy
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摘要:

目的 通过与改良普通喉罩比较,评价声门上喷射通气在无痛纤维支气管镜检查中应用的安全性和可行性。 方法 选择行无痛纤维支气管镜检查的患者80例,年龄22~68岁,采用随机数字表法分为两组(每组40例):声门上喷射通气组(J组)和改良普通喉罩通气组(L组)。记录两组患者一次放置成功率、成功放置时间、检查时间、检查成功率、检查暴露情况以及麻醉前(T0)、插入喉罩(或鼻咽通气道)即刻(T1)、纤维支气管镜通过声门时(T2)、纤维支气管镜通过声门后3 min(T3)及检查结束时(T4)的MAP、HR、SpO2和PETCO2,并记录其并发症。 结果 一次性放置成功率和检查优良率J组(100%,97.5%)明显高于L组(81.1%,81.1%)(P<0.05);成功放置时间和检查时间J组[(10.8±2.6) s,(13±4) min]明显短于L组[(23.2±12.7) s,(23±10) min](P<0.05);J组患者满意度明显优于L组(P<0.05),但操作者满意度组间比较差异无统计学意义(P>0.05);咽痛发生率L组(81.1%)明显高于J组(12.5%)(P<0.05);其他比较差异均无统计学意义(P>0.05)。 结论 声门上喷射通气在无痛纤维支气管镜检查中应用是安全可行性的,且并发症少。

关键词: 声门上; 喷射通气; 纤维支气管镜检查; 气道管理; 喉罩
Abstract:

Objective To evaluate the efficacy and safety of supraglottic jet ventilation and modified laryngeal mask airway during painless fiberbronchoscopy. Methods Eighty patients undergoing painless fiberbronchoscopy were randomly divided into 2 groups(n=40), receiving supraglottic jet ventilation (J group) and modified laryngeal mask airway (L group), respectively. The outcomes of the procedures were recorded, including success rate of the first tubing insertion, the time spent in successful positioning of the tube, the stability of the tube, and related complications. Furthermore, MAP, HR, SpO2 and PETCO2 were monitored before anesthesia(T0), immediately after inserting laryngeal mask airway(or nasopharyngeal ventilation)(T1) or fiberbronchoscope through the glottis(T2), and 3 min(T3) after and by the end of fiberbronchoscopy. Results The success rate of the first tubing insertion and exposure condition in J group(100%, 97.5%) are better than L group(81.1%, 81.1%)(P<0.05). The time spent successfully positioning the insertion and time of check in J group [(10.8±2.6) s, (12.9±4.4) min] are shorter than L group [(23.2±12.7) s, (23.2±9.5) min] (P<0.05). The satisfaction degree of patients in J group is better than that in L group (P<0.05), and there are no significant difference of the satisfaction degree of doctors in two groups (P>0.05). The occurrence of sore throat in J group(81.1%) is less frequent than that in L group(12.5%)(P<0.05). Other complications are not significantly different in two groups(P>0.05). Conclusions Supraglottic jet ventilation for painless fiberbronchoscopy is a safer and more effective procedure than modified laryngeal mask airway.

Key words: Supraglottic; Jet ventilation; Fiberbronchoscopy; Laryngeal mask airway