快充式经鼻湿化高流量通气在双腔支气管插管中的应用

Application of transnasal humidified rapid-insufflation ventilatory exchange during double-lumen endobronchial tube intubation

目的探讨快充式经鼻湿化高流量通气(THRIVE)在双腔支气管插管过程中的应用效果。方法选择择期行胸腔镜下肺叶切除手术需要置入双腔支气管导管的患者50例,随机分为两组,每组25例。T组麻醉诱导前5 min应用THRIVE预充氧,插管时继续高流量通气至确认导管在气管内。C组麻醉前应用面罩预充氧5 min,常规麻醉诱导面罩手控通气。记录入室时(T0)、预充氧5 min(T1)、可视喉镜置入即刻(T2)和支气管导管置入成功即刻(T3)各时间点的HR、MAP、SpO_(2)、PaCO_(2)和PaO_(2)。记录两组气管插管时长,T2~T3时刻PaO_(2)的变化值(△PaO_(2))。结果两组患者均插管成功。两组插管时长和T0时的PaO_(2)无统计学差异(P>0.05)。T3时,T组PaO_(2)高于C组[(343.3±18.6)mmHg vs.(202.8±15.5)mmHg](P<0.05),T2~T3的△PaO_(2)值小于C组[(66.2±10.8)mmHg vs.(213.0±15.1)mmHg](P<0.05)。结论在双腔支气管插管过程中,采用THRIVE技术比常规面罩通气更能减少氧分压的下降,推测会延长窒息氧合时间,提高气管插管安全性。

Objective To evaluate the application efficacy of transnasal humidified rapid-insufflation ventilatory exchange(THRIVE)during double-lumen endobronchial tube intubation.Methods Fifty patients undergoing elective thoracoscopic lung surgery were randomly divided into two groups with 25 cases each.During double-lumen endobronchial tube intubation,THRIVE started at 5 minutes before anesthesia induction was used in group T and conventional mask ventilation was performed in group C.The HR,MAP,SpO_(2),PaCO_(2)and PaO_(2)were recorded at the time points of the time entering operative room(T0),at 5 minutes after preoxygenation(T1),the time of laryngoscope insertion(T2)and immediately after successful intubation(T3).The time spent for intubation and the change values of PaO_(2)(△PaO_(2))from T2 to T3 were recorded.Results Intubation was performed successfully in both groups.The time spent for intubation and PaO_(2)at T0 were not significant different between the two groups(P>0.05).The PaO_(2)at T3 was higher in group T than that in group C[(343.3±18.6)mmHg vs.(202.8±15.5)mmHg](P<0.05).The△PaO_(2)from T2 to T3 was less in group T than that in group C[(66.2±10.8)mmHg vs.(213.0±15.1)mmHg](P<0.05).Conclusion Compared to conventional mask ventilation,the use of THRIVE can more effectively attenuate oxygen pressure reduction during double-lumen endobronchial tube intubation,extend the oxygenation time during asphyxia and improve the safety of endotracheal intubation.