鼻咽通气道应用于放置胃管患者全麻诱导期的临床研究

Clinical study of nasopharyngeal airway in patients with gastric tube placement during induction of general anesthesia

目的观察放置胃管手术患者麻醉诱导期应用鼻咽通气道维持上呼吸道通畅和有效通气的可行性和优越性。方法选择2020年5月—2020年10月在郑州大学第一附属医院放置胃管后拟行择期全麻患者60例,随机数字表法分为面罩(A组)和鼻咽通气道(B组),每组30例,常规全麻诱导,A组面罩加压通气,B组置入一次性鼻咽通气道进行通气,达到插管条件后行气管插管。记录两组患者置入麻醉诱导前(T_(0))、麻醉诱导后1 min(T_(1))、置入鼻咽通气道/面罩加压后(T_(2))和麻醉诱导后3 min(T_(3))时平均动脉压(MAP)、心率(HR)、经皮血氧饱和度(SpO2);T_(2)、T_(3)时刻呼气末二氧化碳(EtCO2)、潮气量(VT)、分钟通气量(MV)、气道峰压(PEAK)和诱导期不良反应。结果A、B两组患者T_(1)、T_(2)和T_(3)时MAP和HR明显低于T_(0)时(P<0.05);T_(1)、T_(2)和T_(3)时SpO2与T_(0)时比较,差异无统计学意义(P>0.05);两组患者T_(0)~T_(3)时MAP、HR和SpO2比较无计学意义(P>0.05)。T_(2)、T_(3)时B组VT、MV明显高于A组(P<0.05),EtCO2、PEAK明显低于A组(P<0.05)。A组患者胃肠胀气发生率高于B组,差异无统计学意义(P>0.05);B组患者鼻粘膜出血发生率高于A组,差异无统计学意义(P>0.05)。结论放置胃管手术患者全麻诱导期应用鼻咽通气道可以维持上呼吸道通畅,达到有效通气,保证患者围术期氧供,值得临床推广。

Objective To observe the feasibility and superiority of using nasopharyngeal airway to maintain upper respiratory tract patency and effective ventilation in patients undergoing gastric tube operation during anesthesia induction.Methods From May 2020 to October 2020,Totally 60 patients scheduled for elective general anesthesia after gastric tube placement in the First Affiliated Hospital of Zhengzhou University were selected and divided into mask group(group A)and nasopharynx airway(group B)based on random number table method,30 cases in each group.After routine anesthesia induction,the patients in group A were received ventilation with add-pressure mask,while those in group B received ventilation with disposable nasopharyngeal airway,and tracheal intubation is performed when intubation conditions are feasible.The mean arterial pressure(MAP),heart rate(HR),percutaneous oxygen saturation(SpO2)were recorded before anesthesia induction(T_(0)),1 min after anesthesia induction(T_(1)),after nasopharynx airway/mask pressure(T_(2))and 3 min after anesthesia induction(T_(3));the end expiratory carbon dioxide(ETCO2),tidal volume(VT),minute ventilation(MV),peak airway pressure(PEAK)were recorded at T_(2),T_(3).and the adverse reactions occurred during induction of general anesthesia were recorded.Results MAP and HR at T_(1),T_(2) and T_(3) in group A and group B were significantly lower than those at T_(0)(P<0.05);There was no significant difference in SpO2 at T_(1),T_(2) and T_(3) compared with T_(0)(P>0.05);MAP,HR and SpO2 at T_(0)-T_(3) between the two groups had no statistical significance(P>0.05).At T_(2) and T_(3),VT and MV in group B were significantly higher than those in group A(P<0.05),while ETCO2 and PEAK were significantly lower than those in group A(P<0.05).The incidence of gastrointestinal flatulence in group A was higher than that in group B,and there was no significant difference between the two groups(P>0.05);The incidence of nasal mucosal bleeding in group B was higher than that in group A,and there was no significant difference between the two groups(P>0.05).Conclusion The application of nasopharyngeal airway in the induction period of general anesthesia for patients undergoing gastric tube can maintain the patency of the upper airway,achieve effective ventilation,and ensure perioperative oxygen supply.It is worthy of clinical promotion.