高频喷射通气在深度镇静麻醉下内窥镜逆行胰胆管造影术中的应用

Application of high frequency jet ventilation in endoscopic retrograde cholangiopancreatography under deep sedation anesthesia

目的 探讨高频喷射通气在深度镇静麻醉下内窥镜逆行胰胆管造影术(ERCP)中的安全性和有效性。方法 选取我院2017年6月—2018年8月择期行ERCP手术的患者60例,按随机数字表法分为高频喷射通气组(H组)和普通鼻导管吸氧组(C组)各30例。两组患者均静注芬太尼1μg/kg,丙泊酚靶控输注麻醉。H组使用高频喷射呼吸机行高频通气辅助呼吸,C组单纯使用鼻导管吸氧。指标观察的时间点分为入室后(T0)、诱导后(T1)、十二指肠镜过食道时(T2)、Oddi括约肌切开时(T3)、手术结束时(T4)和苏醒时(T5),记录各时点的心率(HR)、平均动脉压(MAP)、血氧饱和度(SpO2)和呼吸末二氧化碳浓度(ETCO2);记录术中并发症及苏醒情况。结果 与C组T1、T2、T3、T4时血氧饱和度(SpO2)相比,H组明显升高,差异均有统计学意义(P<0.05);H组患者术中体动和低氧血症发生率均较C组少,苏醒时间明显缩短,差异均有统计学意义(P<0.05);与C组内镜操作医生满意度比较,H组满意度明显增高,差异有统计学意义(P<0.05)。结论 高频喷射通气在深镇静麻醉下ERCP术中的应用是安全有效的。

Objective To investigate the safety and efficiency of high frequency jet ventilation in endoscopic retrograde cholangiopancreatography(ERCP)under deep sedation anesthesia.Methods Sixty patients who underwent ERCP from June 2017 to August 2018 in the Third Affiliated Hospital of Guangxi University of Chinese Medicine were selected,and they were divided into a high frequency jet ventilation group(group H)and a nasal catheter oxygen inhalation group(group C)according to a random number table method,each group included 30 cases.Intravenous injection of 1μg/kg fentanyl anesthesia was first administered for the two groups,then followed by target controlled infusion of propofol anesthesia.Group H was administered with high frequency ventilation assisted breathing by high frequency jet ventilator.Group C used single nasal catheter oxygen inhalation.Indexes were observed at the time points after patients entering the operating room(T0),after induction(T1),while duodenoscopy passing through esophagus(T2),while Sphincter of Oddi incision(T3),at the end of operation(T4)and at the awakening time(T5).The heart rate(HR),mean arterial pressure(MAP),blood oxygen saturation(SpO 2)and end-respiratory carbon dioxide concentration(ETCO 2)were recorded at each time pints.Intra-operation complications and awakening state were recorded.Results Compared with group C,the SpO 2 at time points of T1,T2,T3 and T4 was significantly higher in group H,there were all statistically significant differences(P<0.05).Patients in group H had lower occurrence rates of body movement and hypoxemia during operation,and had obviously shorter awakening time than those in group C,there were all statistically significant differences(P<0.05).The degree of endoscopic surgeon satisfaction of group H was significantly higher than that of group C,and the difference was statistically significant(P<0.05).Conclusion High frequency jet ventilation in ERCP under deep sedation anesthesia is safe and effective.