声门上喷射通气在规范化培训中的应用研究

Clinical application of supraglottic jet oxygenation in resident standardization training

目的评价声门上喷射通气在规范化培训中应用的可行性。方法择期年龄≥18岁,ASA分级Ⅰ~Ⅱ级,无严重的心、肺、肝、肾疾病,无鼻衄和鼻部手术史,无血液疾病、麻醉药物过敏史患者100例,随机均分为面罩组、喷射组。记录诱导前(T0)、通气后1 min(T_(1))、3 min(T_(2))、5 min(T_(3))的SpO_(2)、PaO_(2)、PaCO_(2)、膈肌运动振幅值。结果面罩组出现低氧血症患者4例,两组均未出现其它不良事件。膈肌振幅、PaO_(2)两组在T_(1)~T_(3)时均小于T0时(P<0.05),面罩组在T_(1)~T_(3)时逐渐降低,不同时间点间比较差异均有统计学意义(P<0.05),而喷射组未见明显变化(P>0.05)。PaCO_(2)在喷射组T0~T_(3)时均无明显变化(P>0.05),面罩组T0、T_(1)时明显低于T_(2)、T_(3)(P<0.05),T_(2)、T_(3)时喷射组也明显低于面罩组(P<0.05)。SpO_(2)在两组间比较及组内比较差异均无统计学意义(P>0.05)。结论声门上喷射通气作为在规范化培训的内容是安全可行的。

Objective To evaluate the feasibility of supraglottic jet ventilation in resident standardization training.Methods 100 patients of ASA Ⅰ~Ⅱ,aged≥18 years,no severe heart,lung,liver,kidney disease,no history of epistaxis or nasopharyngeal surgery,no allergy to the study drug or diseases of the bleeding requiring nasal tracheal intubation under general anesthesia,were randomly divided into 2 groups:mask ventilation group(MV group)and supraglottic jet oxygenation group(SJ group).SpO_(2),PaO_(2),PaCO_(2),amplitude of diaphragm movement before anesthesia induction(T0)and 1 min(T_(1)),3 min(T_(2)),5 min(T_(3))after controlled ventilation in the two groups were recorded.Results 4 patients occurred incidence of hypoxemiain in the MV group,no patient had other adverse events in the two groups.The diaphragm amplitude and PaO_(2) of the two groups were lower at T_(1)~T_(3) than that at T0,and decreased gradually at T_(1)~T_(3),and there were significant differences at different time points in the MV group(P<0.05).but there was no significant change in the SJ group(P>0.05).There was no significant change in PaCO_(2) during T_(0)~T_(3) in the SJ group,but the levels of T0 and T_(1)in the MV group were significantly lower than those in T_(2)and T_(3)(P<0.05),and those in the T_(2)and T_(3) group were also significantly lower than those in the MV group(P<0.05).There was no significant difference in SpO_(2) between the two groups and within the two groups.Conclusion Supraglottic jet ventilation is safe and feasible in resident standardization training.