高频喷射通气在无痛纤维支气管镜超声定位针刺活检中的应用

Application of High-Frequency Jet Ventilation in Painless Fiberoptic Bronchoscopy Guided Needle Biopsy

目的:探讨高频喷射通气在无痛纤维支气管镜超声定位针刺活检中的应用效果。方法:回顾性分析2018年6月~2019年12月在本院实施无痛纤维支气管镜超声定位针刺活检的90例患者的临床资料,根据活检过程中不同的供氧方式分为A组(经鼻咽通气道接高频喷射通气,46例)、B组(经鼻咽通气道接高流量氧吸入,44例)。统计并比较两组置入纤维支气管时及活检完成撤镜时的血气指标,并比较两组活检期间不良事件发生率。结果:置入纤维支气管镜时A组动脉血氧分压(PaO_(2))为(90.78±2.86)mmHg、动脉血二氧化碳分压(PaCO_(2))为(36.87±1.82)mmHg、外周动脉血氧饱和度(SpO_(2))为(97.49±2.47)%;B组PaO_(2)为(90.68±2.35)mmHg、PaCO_(2)为(36.85±1.81)mmHg、SpO_(2)为(97.53±2.45)%。活检完成撤镜时,A组PaO_(2)为(92.87±2.42)mmHg、PaCO_(2)为(39.13±2.95)mmHg、SpO_(2)为(98.89±1.06)%;B组PaO_(2)为(82.12±2.68)mmHg、PaCO_(2)为(40.22±2.38)mmHg、SpO_(2)为(93.44±2.64)%。A组活检完成撤镜时的PaO_(2)、SpO_(2)均高于置入纤维支气管镜时,PaCO_(2)高于置入纤维支气管镜时;B组活检完成撤镜时的PaO_(2)、SpO_(2)均低于置入纤维支气管镜时,PaCO_(2)高于置入纤维支气管镜时,差异有统计学意义(t=18.598、5.454、8.914,P均<0.001)。活检期间,A组不良事件发生率为4.34%(2/46)明显低于B组18.18%(8/44),差异有统计学意义(χ^(2)=4.748,P=0.029)。结论:经鼻咽通气道接高频喷射通气用于无痛纤维支气管镜超声定位针刺活检中的效果较为显著,能有效改善患者活检期间的血气指标,降低不良事件发生率,更为安全有效。

Objective:To explore the application effect of high-frequency jet ventilation in painless fiberoptic bronchoscope ultrasound positioning needle biopsy.Methods:The clinical data of 90 patients who underwent painless fiberoptic bronchoscopy ultrasound guided needle biopsy in our hospital from June 2018 to December 2019 were retrospectively analyzed.According to different oxygen supply methods during the biopsy,they were divided into group A(46 cases via nasopharyngeal airway connected with high-frequency jet ventilation)and group B(44 cases via nasopharyngeal airway connected with high-flow oxygen inhalation).The blood gas indexes of the two groups when the fiberoptic bronchus was inserted and when the biopsy was completed,and the incidence of adverse events during biopsy were compared between the two groups.Results:In group A,arterial oxygen partial pressure(PaO_(2))was(90.78±2.86)mmHg,arterial carbon dioxide partial pressure(PaCO_(2))was(36.87±1.82)mmHg,and peripheral arterial oxygen saturation(SpO_(2))was(97.49±2.47)%;In group B,PaO_(2) was(90.68±2.35)mmHg,PaCO_(2) was(36.85±1.81)mmHg and SpO_(2) was(97.53±2.45)%.After biopsy,PaO_(2) was(92.87±2.42)mmHg,PaCO_(2) was(39.13±2.95)mmHg and SpO_(2) was(98.89±1.06)%;In group B,PaO_(2) was(82.12±2.68)mmHg,PaCO_(2) was(40.22±2.38)mmHg and SpO_(2) was(93.44±2.64)%.In group A,PaO_(2) and SpO_(2) after biopsy were higher than those after fiberoptic bronchoscopy,and PaCO_(2) was higher than that after fiberoptic bronchoscopy;In group B,PaO_(2) and SpO_(2) after biopsy were lower than those after fiberoptic bronchoscopy,and PaCO_(2) was higher than that after fiberoptic bronchoscopy(t=18.598,5.454,8.914,P<0.001).During biopsy,the incidence of adverse events in group A was 4.34%(2/46),which was significantly lower than 18.18%(8/44)in group B,and the difference was statistically significant(χ^(2)=4.748,P=0.029).Conclusion:The effect of high-frequency jet ventilation through nasopharyngeal airway for painless fiberoptic bronchoscope ultrasound positioning needle biopsy is more significant,which can effectively improve the blood gas indicators during biopsy,reduce the incidence of adverse events,and is safer and more effective.