比较快充式经鼻湿化高流量通气与面罩通气对老年缺牙病人安全无通气时间的影响

doi:10.3969/j.issn.1003-9198.2022.11.011

摘要/Abstract

摘要： 目的比较快充式经鼻湿化高流量通气(transnasal humidified rapid-insufflation ventilatory exchange, THRIVE)与面罩通气对老年缺牙病人全身麻醉诱导后安全无通气时间的影响。方法选择缺牙颗数≥10颗的老年病人50例,随机分为面罩组(M组)和THRIVE组(T组)。麻醉诱导前预充氧阶段,M组行全麻面罩纯氧通气,T组经THRIVE预充氧。全身麻醉诱导后,M组行压力控制通气,T组调整流量至70 L/min。注射肌松剂4 min后,M组停止面罩通气,T组继续经鼻导管通气。当安全无通气时间达到8 min或SpO₂降至95%结束试验,并立即行可视喉镜气管内插管。记录2组安全无通气时间达到8 min的例数、再氧合时间;记录不同时点的HR、MAP、PaO₂及PaCO₂;记录病人通气及气管内插管相关并发症发生情况。结果 T组每例病人安全无通气时间都能达到8 min,M组只有6例(24%)病人安全无通气时间达到8 min(P<0.05)。T组较M组再氧合时间明显缩短(P<0.05)。2组病人预充氧后的PaO₂均升高,而在模拟窒息气管内插管期间,M组PaO₂明显降低,T组略有下降(P<0.05)。与基础PaCO₂比较,2组窒息氧合期的PaCO₂均升高,T组PaCO₂较M组明显升高(P<0.05)。2组病人不同时点的血流动力学指标以及气管插管和通气相关并发症发生率差异均无统计学意义(P>0.05)。结论在老年缺牙病人全身麻醉诱导期间使用THRIVE通气,与面罩通气相比,可改善病人氧合,延长安全无通气时间,缩短再氧合时间。

关键词: 快充式经鼻湿化高流量通气, 老年人, 缺牙, 窒息氧合, 安全无通气时间

Abstract: Objective To compare the effects of transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) and mask ventilation on oxygenation and duration of safe apnea after induction of general anesthesia in the elderly patients with tooth less. Methods Fifty elderly patients with tooth less(missing more than 10 teeth) were divided into facemask group (group M) and THRIVE group (group T). In the preoxygenation stage before induction of anesthesia, facemask was used in group M, while THRIVE was used in group T. After the induction of general anesthesia, group M underwent pressure-controlled ventilation, and group T adjusted the flow to 70 L/min. After the muscle relaxant was injected for 4 min, group M stopped the mask ventilation, while group T continued ventilation. When the duration of safe apnea reached 8 min or the level of pulse oxygen saturation (SpO₂) dropped to 95%, the experiment was terminated, and the endotracheal intubation was performed immediately with a visual laryngoscope. The cases with duration of safe apnea reaching 8 min, reoxygenation time, and the levels of arterial partial pressure of oxygen(PaO₂), arterial partial pressure of carbon dioxide(PaCO₂), heart rate(HR), mean arterial pressure(MAP) in different time points were recorded. The ventilation and endotracheal intubation-related complications were recorded and compared between the two groups. Results All the patients in group T had a duration of safe apnea of 8 min, while only 6 patients (24%) in group M had a duration of safe apnea of 8 min (P<0.05). Compared with group M, the reoxygenation time in group T was significantly shorter (P<0.05). The level of PaO₂ in the two groups increased after preoxygenation. During simulating apneic tracheal intubation period, the level of PaO₂ decreased significantly in group M, while decreased slightly in group T(P<0.05). Compared with the basic level, the level of PaCO₂ during apneic period increased signifcantly in both groups, especially in group T (P<0.05). There were no significant differences in the hemodynamic indicators and the incidence rate of the complications related to endotracheal intubation and ventilation between the two groups (P>0.05). Conclusions Compared with facemask, THRIVE can significantly prolong the duration of safe apnea after induction of general anesthesia in the elderly patients with tooth less and reduce the reoxygenation time.

Key words: transnasal humidified rapid-insufflation ventilatory exchange, aged, tooth less, apenic oxygenation, duration of safe apnea

中图分类号:

R614.2

汪婉玲, 徐亚杰, 张文文, 张勇, 张晨, 史宏伟, 鲍红光, 王晓亮. 比较快充式经鼻湿化高流量通气与面罩通气对老年缺牙病人安全无通气时间的影响[J]. 实用老年医学, 2022, 36(11): 1124-1128.

WANG Wan-ling, XU Ya-jie, ZHANG Wen-wen, ZHANG Yong, ZHANG Chen, SHI Hong-wei, BAO Hong-guang, WANG Xiao-liang. Comparison of the effects of transnasal humidified rapid-insufflation ventilatory exchange and mask ventilation on duration of safe apnea in elderly patients with tooth less[J]. Practical Geriatrics, 2022, 36(11): 1124-1128.

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