非麻醉专业住院医师应用声门上喷射通气进行全身麻醉的效果

Effect of general anesthesia with supraglottic jet ventilation performed by residents not majoring in anesthesiology

目的观察非麻醉专业住院医师采用声门上喷射通气进行全身麻醉的效果。方法将92例行经鼻气管插管全身麻醉的患者随机分为常规组43例与喷射组49例。麻醉诱导后由非麻醉专业住院医师进行气道管理,常规组应用常规单手“C-E手法”扣面罩进行通气,喷射组应用声门上喷射通气。记录两组患者在麻醉诱导前(T_(0))及麻醉诱导后1 min(T_(1))、3 min(T_(2))、5 min(T_(3))的脉搏血氧饱和度(SpO_(2))、PaO_(2)、PaCO_(2),并计算以上时间点前1 min内的膈肌运动振幅值。记录不良事件发生情况。结果两组患者的SpO_(2)、PaO_(2)、PaCO_(2)及膈肌运动振幅均有随时间变化的趋势(均P<0.05);喷射组T_(2)、T_(3)时的PaO_(2)高于常规组,T_(3)时的PaCO_(2)低于常规组(均P<0.05),但两组患者的膈肌运动振幅差异无统计学意义(P>0.05)。两组患者均未出现气胸、纵隔气肿、皮下气肿、鼻出血等情况,而喷射组患者胃通气发生率低于常规组(P<0.05)。结论非麻醉专业住院医生应用声门上喷射通气能给全身麻醉患者提供相对更恒定的通气量,并可降低胃通气发生率。

Objective To observe the effect of general anesthesia with supraglottic jet ventilation performed by residents not majoring in anesthesiology.Methods Ninety-two patients undergoing general anesthesia through nasotracheal intubation were randomly divided into conventional group(43 cases)and jet group(49 cases).After anesthesia induction,residents not majoring in anesthesiology performed airway management.The conventional group received conventional face-mask ventilation using the one-handed"C-E clamp technique",whereas the jet group received supraglottic jet ventilation.Patients′pulse oxygen saturation(SpO_(2)),PaO_(2),and PaCO_(2) before the anesthesia induction(T_(0))and one(T_(1)),three(T_(2))and five minutes(T_(3))after the anesthesia induction were recorded in the two groups,and the values of diaphragmatic motion amplitude within one minute before the aforementioned time points were calculated.The incidence of adverse events was recorded.Results SpO_(2),PaO_(2),PaCO_(2),and diaphragmatic motion amplitude changed over time in both groups(all P<0.05).The jet group yielded higher PaO_(2) at T_(2) and T_(3) and a lower PaCO_(2) at T_(3) than the conventional group(all P<0.05).However,there was no statistically significant difference in the diaphragmatic motion amplitude between the two groups(P>0.05).No pneumothorax,mediastinal emphysema,subcutaneous emphysema or epistaxis occurred in the two groups,while the incidence rate of gastric insufflation in the jet group was lower than that in the conventional group(P<0.05).Conclusion Supraglottic jet ventilation performed by residents not majoring in anesthesiology can provide a relatively more constant ventilation volume for patients undergoing general anesthesia,which can also reduce the incidence rate of gastric insufflation.