高频喷射通气辅助呼吸在非插管全麻下经皮椎体成形术中的应用

Application of high frequency jet ventilation assisted breathing in percutaneous vertebroplasty under non-intubated general anesthesia

目的探讨高频喷射通气辅助呼吸在非插管全麻下经皮椎体成形术(PVP)中的安全性和有效性。方法选取柳州市中医医院2015年10月至2016年10月择期行单节段椎体PVP手术的患者60例,男性13例,女性47例,年龄50~85岁,体质量40~72 kg,ASAⅠ~Ⅲ级。按随机数表法分为高频喷射通气组(H组)和普通面罩吸氧组(C组)各30例。两组患者均先用芬太尼1μg/kg,然后采用丙泊酚靶控输注(Marsh模型)。H组使用高频喷射呼吸机行高频通气辅助呼吸治疗,C组单纯面罩吸氧。记录入室后(T0)、诱导前1 min(T1)、诱导后1 min(T2)、手术开始时(T3)、手术开始后10 min(T4)、手术结束时(T5)、苏醒时(T6)的心率(HR)、平均动脉压(MAP)、血氧饱和度(SpO_2)值;记录T0,T1,T3,T4,T5时间点的动脉血氧分压(PaO_2)、动脉血二氧化碳分压(PCO_2);记录术中变化及苏醒情况。结果与C组患者的手术时间[(28.6±4.1)min vs(26.1±4.1)min]、丙泊酚用量[(237.7±24.0)mg vs(223.7±25.9)mg]比较,H组患者的手术时间,丙泊酚用量均明显降低,差异均有统计学意义(P<0.05);与C组患者T3,T4,T5时的PO_2比较,H组患者T3、T4、T5时的PO_2值明显增高,差异均有统计学意义(P<0.05);与C组患者T4,T5时的PCO_2比较,H组患者T4,T5时的PCO_2明显降低,差异均有统计学意义(P<0.05);与C组患者术中体动,低氧血症比较,H组患者术中体动、低氧血症发生次数明显减低,差异均有统计学意义(P<0.05);H组患者的苏醒时间为(5.3±1.4)min,明显少于C组患者的(6.0±1.5)min,差异有统计学意义(P<0.05)。结论高频喷射通气辅助呼吸在非插管全麻下PVP手术是安全有效的。

Objective To investigate the safety and efficacy of high frequency jet ventilation assisted breathing in percutaneous vertebroplasty（PVP） under non-intubated general anesthesia. Methods A total of 60 patients were selected in this study, who underwent single-segment vertebral PVP surgery in Liuzhou Hospital of Traditional Chinese Medicine from October 2015 to October 2016. There were 13 males and 47 females, aged 50~85 years old, with body mass 40~72 kg, ASA Ⅰ~Ⅲ. They were divided into high frequency jet ventilation group（group H） and basic breather face mask group（group C） according to the random number table method（30 cases in each group）. In both groups, fentanyl 1μg/kg was administered firstly, followed by target controlled infusion of propofol（Marsh model）. Group H was treated with high frequency jet ventilator for assisted ventilation therapy, and group C accepted basic breather face mask for oxygen inhalation. The following time points were selected： entering the operation room（T0）, 1 min before induction（T1）, 1 min after induction（T2）, at the beginning of the operation（T3）, 10 min after the start of surgery（T4）, at the end of operation（T5） and the recovery time（T6）, and the patient＇s heart rate（HR）, mean arterial pressure（MAP）, blood oxygen saturation（SpO2） values were recorded. The arterial oxygen partial pressure（PaO2） and arterial blood carbon dioxide partial pressure（PCO2） at T0, T1, T3, T4, T5 were recorded. Then the recovery time of anesthesia and adverse reactions during the recovery period were recorded. Results Compared with the operation time and the dosage of propofol used in patients of group C, the data of group H were decreased significantly：（26.1 ± 4.1） min vs（28.6 ± 4.1） min, P0.05;（223.7±25.9） mg vs（237.7±24.0） mg, P0.05. Compared with PO2 in group C at T3, T4 and T5, the PO2 values of the corresponding time in group H were all significantly increased（P0.05）; while compared with PCO2 at T4 and T5 in group C, the PCO2 in group H decreased significantly at the same time point（P0.05）. Compared with the body movement and hypoxemia during operation in group C, the two indexes in group H were significantly reduced（P0.05）.The recovery time of patients in group H was（5.3±1.4） min, which was significantly less than（6±1.5） min of group C（P0.05）. Conclusion High frequency jet ventilation assisted breathing is safe and effective in PVP surgery under non-intubated general anesthesia.