2021 年第 4 期 第 16 卷

经喉罩不同喷射通气模式在气道介入治疗中的效果比较

Comparison of the effects of different jet ventilation modes via laryngeal mask on airway interventional therapy

作者：徐璟1蔡垣星1李天佐2李蕾1

英文作者：Xu Jing1 Cai Yuanxing1 Li Tianzuo2 Li Lei1

单位：1应急总医院麻醉科，北京100028；2首都医科大学附属北京世纪坛医院麻醉科100038

英文单位：1Department of Anesthesiology Emergency General Hospital Beijing 100028 China; 2Department of Anesthesiology Beijing Shijitan Hospital Capital Medical University Beijing 100038 China

关键词：

英文关键词：Laryngealmask；Airwayinterventionaltherapy；Highfrequencyjetventilation

• 摘要：

• 目的 比较经喉罩不同喷射通气模式在气道介入治疗中的效果。方法 选取应急总医院2019年1—5月行全身麻醉气道介入治疗患者60例，按照随机数字表法分为高频喷射通气组（HFJV组）和高频叠加喷射通气组（SHFJV组），每组30例。记录2组患者入室未吸氧（基础值，T0）、置入喉罩（T1）、手术开始（T2）、喷射通气20 min（T3）、术毕（T4）各时点的平均动脉压（MAP）、心率和脉搏血氧饱和度（SpO2），T0和T3时点动脉血氧分压（PaO2）、动脉血二氧化碳分压（PaCO2）和pH值，T3时点气道内吸气压力峰值（PIP）、平均气道压（mPaw）和呼气末正压（PEEP），手术时间，苏醒时间，以及术中不良反应发生情况。结果 2组患者各时点MAP、心率比较差异均无统计学意义（均P＞0.05）。T3时点SHFJV组SpO2、PaO2和pH值均明显高于HFJV组［（98.6±1.0）%比（97.2±1.6）%、（256±55）mmHg（1 mmHg=0.133 kPa）比（193±74）mmHg、（7.38±0.05）比（7.28±0.07）］，PaCO2明显低于HFJV组［（41±5）mmHg比（51±6）mmHg］（均P＜0.05）。T3时点SHFJV组气道内PIP、mPaw和PEEP均明显高于HFJV组（均P＜0.001）。2组手术时间和患者苏醒时间比较，差异均无统计学意义（均P＞0.05）。2组术中不良反应发生率比较差异均无统计学意义（均P＞0.05）。结论 全身麻醉下气道介入治疗，采用经喉罩SHFJV较单一HFJV，能更有效地保证术中氧供并降低二氧化碳蓄积风险。

• Objective To compare the effects of different jet ventilation modes via laryngeal mask on airway interventional therapy. Methods From January to May 2019, 60 patients with general anesthesia and airway interventional therapy in Emergency General Hospital were selected. They were randomly divided into high frequency jet ventilation group (HFJV group) and superimposed high frequency jet ventilation group (SHFJV group), with 30 cases in each group. Mean arterial blood pressure(MAP), heart rate and pulse oxygenation(SpO2) were recorded after entering the operating room(base value, T0), inserting laryngeal mask (T1), beginning the operation (T2), jet ventilation for 20 min (T3) and the end of operation(T4). The arterial oxygen partial pressure（PaO2）, arterial carbon dioxide partial pressure（PaCO2） and pH were recorded at T0 and T3. Peak inspiratory pressure(PIP), average airway pressure (mPaw) and positive end-expiratory pressure （PEEP） were measured at T3. The operative time, awakening time and the adverse events during the operation were recorded. Results There were no significant differences in MAP and heart rate between the 2 groups at all time points (all P＞0.05). SpO2, PaO2 and pH at T3 in SHFJV group were significantly higher than those in HFJV group ［（98.6±1.0）% vs （97.2±1.6）%, （256±55）mmHg vs （193±74）mmHg,（7.38±0.05） vs （7.28±0.07）］, and PaCO2 in SHFJV group was significantly lower than that in HFJV group ［（41±5）mmHg vs （51±6）mmHg］(all P＜0.05). At T3, PIP, mPaw and PEEP in SHFJV group were significantly higher than those in HFJV group (all P＜0.001). There were no significant differences in operation time and awakening time between the two groups (both P＞0.05). There was no significant difference in the incidence of adverse reactions between the two groups (all P＞0.05). Conclusion SHFJV via laryngeal mask is more effective than single HFJV in airway interventional therapy with general anesthesia, which can ensure oxygen supply and reduce the risk of carbon dioxide accumulation.