应用经鼻湿化快速充气交换通气技术行全麻纤支镜诊疗32例并文献复习

doi:10.6040/j.issn.1673-3770.0.2023.246

摘要/Abstract

摘要： 目的研究经鼻湿化快速充气交换通气技术(transnasal humidified rapid insufflation ventilitory exchange, THRIVE)通气技术在全麻纤支镜诊疗中的应用安全性和可行性。方法收集2022年8月至2023年5月于山东大学第二医院气管镜室采用行纤维支气管镜诊疗的患者32例。患者雾化吸入表麻后,进行全身麻醉复合THRIVE技术进行纤支镜诊疗。分别在全麻前和手术结束各采集动脉血行血气分析,并记录总麻醉时长。术后次日随访术后恢复和并发症情况。结果 32例患者均未见术中及术后并发症,其中5例患者因脉氧下降改为喉罩通气,其中4例为鼾症,其余27例平均麻醉时长(20.75±6.70)min,期间无机械辅助通气,SpO₂持续维持95%以上。动脉血气分析PO₂较术前无统计学差异,动脉血气PO₂与总麻醉时长无线性关系;PCO₂和TCO₂均在术后升高,PH术后降低,PCO₂随麻醉时长延长而升高,PH随麻醉时长延长而下降。BE与术前差异无统计学意义。结论在全麻纤支镜手术中,应用THRIVE通气技术具有特殊的优势,能够在提供充足氧供的基础上,使操作更便捷舒适,且不会引起明显并发症。其应用有一定的局限性,有鼾症等使气道狭窄因素的患者未获得满意的无呼吸氧合时间。该技术会导致术中CO₂蓄积,限制手术时间。

关键词: 经鼻湿化快速充气交换通气技术, 全身麻醉, 纤维支气管镜, 血气分析

Abstract: Objective To study the use of transnasal humidified rapid insufflation ventilatory exchange(THRIVE)ventilation technology in bronchofiberoscopy under general anesthesia. Methods A total of 32 patients requiring bronchoscopy under general anesthesia at The Second Hospital of Shandong University between August 2022 and May 2023 were selected for this study. Each received atomizing inhalation of local anesthesia, after which bronchofiberoscopy was initiated under general anesthesia. Arterial blood samples were collected for blood gas analysis before the anesthesia was administered and during the recovery period following each procedure. The total anesthesia time was recorded. The patients were followed up with on the next day after the procedure. Results No intraoperative or postoperative complications were observed in any of the 32 patients. Among them, five patients(four of whom snored)were switched to low-minute volume owing to oxygen desaturation. The average anesthesia time of the remaining 27 patients was 20.75±6.70 minutes. Oxygen partial pressure(SpO₂)was maintained above 95% throughout the procedure. The postoperative SpO₂ values were slightly higher than the preoperative ones, although the difference was not statistically significant. No significant correlation was identified between SpO₂ and total anesthesia time. Carbon dioxide partial pressure(SPCO₂)and total CO₂ were significantly increased following the administration of the anesthesia. However, PH was significantly reduced. Both the increase in SPCO₂ and the decrease in PH were positively correlated with the duration of the anesthesia. No significant differences were observed in terms of BE values. Conclusion THRIVE carries certain advantages for bronchofiberoscopy procedures performed under general anesthesia-particularly in terms of providing sufficient oxygen to the patient. Moreover, THRIVE can also make the procedure convenient and comfortable for the patient, without causing any obvious complications. However, certain limitations to the use of THRIVE exist. Patients with stenosis in their airways, such as those who snore, often cannot achieve a satisfactory apnea time. This technique may lead to CO₂ accumulation, which can limit the time available to complete the procedure. With much interest, we await the development of new techniques to adequately remove CO₂ from the lungs, which may lead to a wide adoption of THRIVE.

Key words: Transnasal humidified rapid insufflation ventilatory exchange, General anesthesia, Bronchofiberscope, Arterial blood gas analysis

中图分类号:

R614.2

董绪德,王乔蓓,王莹,马兴旺,李传刚. 应用经鼻湿化快速充气交换通气技术行全麻纤支镜诊疗32例并文献复习[J]. 山东大学耳鼻喉眼学报, 2024, 38(4): 115-120.

DONG Xude, WANG Qiaobei, WANG Ying, MA Xingwang, LI Chuangang. Practical use of THRIVE to administer general anesthesia for bronchofiberoscopy in 32 cases[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2024, 38(4): 115-120.

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