全麻诱导合并呼气末正压通气在麻醉科气管插管规培教学中的应用

Application of positive end-expiratory pressure during anesthesia induction improves intubation proficiency among anesthesia residents

目目的:评价合并呼气末正压的全麻诱导面罩通气对安全呼吸暂停时间的影响,并评价其对规培生培训的效果及可行性。方法:选取2021年11月-12月在某医院第一医学中心麻醉科轮转的无插管经验的非麻醉专业规培医生10名,以及全麻气管插管患者30例,随机分为两组:应用呼气末正压的面罩通气组(P组)及不应用呼气末正压的传统面罩通气组(T组)。两组在麻醉诱导给药后行纯氧面罩机械通气,T组应用小潮气量容量控制模式通气,P组在T组通气方法的基础上加用呼气末正压(6cmH_(2)O)。观察指标为两组患者的呼吸暂停时间及氧合水平,两组学员的插管成功率、带教效果等。结果:P组及T组学员均取得了良好的培训效果;两组学员气管插管成功率,即SpO_(2)降至96%前成功完成气管插管的比例,P组为100%,T组为86.7%;两组患者的呼吸暂停时间,即SpO_(2)降至90%所需时间,P组患者明显优于T组;两组患者的氧分压,P组患者明显优于T组,上述指标差异均具有统计学意义(P<0.01)。结论:在规培生带教工作中,全麻诱导期应用呼气末正压可提高学员的插管成功率,获得更好的带教效果。

Objective:To evaluate the effects of positive end-expiratory pressure(PEEP)during anesthesia induction on non-hypoxemic apnea time and oxygenation before intubation and its feasibility on anesthesia training for residents.Methods:A total of 10 residents from First Medical Center of Chinese PLA General Hospital were randomly allocated to PEEP group and traditional group.And 30 patients scheduled for surgery under general anesthesia were also enrolled.Non-hypoxemic apnea time,oxygenation levels,initial intubation success rates,and performance before and after training were assessed and compared.Results:Satisfactory training results were achieved in both groups.Comparing the successful rate of endotracheal intubation,intubate the patient before SpO_(2) drop to 96%,for groups P and T was 100% and 86.7%,respectively.The non-apnea time,the duration for Sp0_(2),to drop to 90%,of patients in group P were significantly better than those in group T.When comparing the PaO_(2),between the two groups,the patients in group P were significantly higher than those in group T,and the differences between these parameters were statistically significant(P<0.01).Conclusion:The application of PEEP improves the successful rate of endotracheal intubation of anesthesia residents,which further achieved better teaching results.