经鼻湿化快速充气交换通气技术在颈椎骨折患者经鼻清醒气管插管中的应用

Application of transnasal humidified rapid-insufflation ventilation exchange for awake fiberoptic nasotracheal intubation in patients with cervical fracture

目的探讨经鼻湿化快速充气交换通气技术(THRIVE)在颈椎骨折患者经鼻清醒气管插管中的应用效果。方法选择择期行颈椎骨折手术患者50例,男26例,女24例,年龄18~64岁,BMI 18~30 kg/m^(2),ASAⅠ—Ⅲ级。随机分为两组:面罩+鼻导管组(M组)和THRIVE组(T组),每组25例。M组面罩吸纯氧10 L/min,T组使用THRIVE吸纯氧30 L/min,两组均预充氧5 min后予镇静镇痛,M组采用普通鼻导管吸纯氧,氧流量10 L/min,T组吸纯氧氧流量调至70 L/min,进行纤维支气管镜引导下经鼻清醒气管插管。记录入室时、预充氧5 min后及清醒气管内插管成功即刻HR、MAP、SpO_(2)、PaO_(2)、PaCO_(2),插管期间SpO_(2)<95%发生率,插管期间SpO_(2)最低值,插管期间不良反应。结果与入室时比较,预充氧5 min后两组SpO_(2)、PaO_(2)明显升高(P<0.05),插管成功即刻M组PaO_(2)、PaCO_(2),T组SpO_(2)、PaO_(2)、PaCO_(2)明显升高(P<0.05)。与预充氧5 min后比较,插管成功即刻M组SpO_(2)、PaO_(2)明显降低(P<0.05),PaCO_(2)明显升高(P<0.05),T组PaO_(2)明显降低(P<0.05),PaCO_(2)明显升高(P<0.05)。插管成功即刻T组SpO_(2)、PaO_(2)明显高于M组(P<0.05),PaCO_(2)明显低于M组(P<0.05)。插管期间T组SpO_(2)<95%发生率明显低于M组(P<0.05),SpO_(2)最低值明显高于M组(P<0.05)。两组清醒插管期间不良反应发生率差异无统计学意义。结论经鼻湿化快速充气交换通气技术较传统面罩鼻导管给氧法能更好地维持纤维支气管镜引导下经鼻清醒气管内插管期间患者的氧合,减少二氧化碳潴留,未增加通气相关并发症。

Objective To evaluate the effect of transnasal humidified rapid-insufflation ventilation exchange(THRIVE)for awake fiberoptic nasotracheal intubation in patients with cervical fracture.Methods Fifty patients with cervical fracture posted for elective surgery,26 males and 24 females,aged 18-64 years,BMI 18-30 kg/m^(2),ASA physical statusⅠ-Ⅲ,were randomly divided into two groups:facemask plus nasal catheter oxygen inhalation group(group M)and THRIVE group(group T),25 patients in each group.The patients in group M spontaneously inhaled pure oxygen at 10 L/min through a facemask for preoxygenation,while group T was administered pure oxygen at 30 L/min through THRIVE.All patients received sedation at the end of preoxygenation for 5 minutes.Patients in group M received 10 L/min pure oxygen through a nasal catheter,while those in group T received pure oxygen at a flow rate of 70 L/min.And then the patients were undergoing awake fiberoptic nasotracheal intubation.The incidence rate of SpO_(2)<95%and the lowest SpO_(2) during intubation,HR,MAP,SpO_(2),PaO_(2),and PaCO_(2) at the time of entering the room,5 minutes after preoxygenation and immediately after awake tracheal intubation,adverse effects during the procedure were recorded.Results Compared with entering the room,SpO_(2) and PaO_(2) were increased after preoxygenation in the two groups(P<0.05).Compared with the time entering the room,PaO_(2),PaCO_(2) in group M and SpO_(2),PaO_(2),PaCO_(2) in group T were increased after intubation(P<0.05).Compared with 5 minutes preoxygenation,SpO_(2),PaO_(2) were decreased(P<0.05),PaCO_(2) was increased(P<0.05)in group M and PaO_(2) was decreased(P<0.05),PaCO_(2) was increased(P<0.05)in group T after intubation.Compared with group M,SpO_(2),PaO_(2) in group T were increased(P<0.05)and PaCO_(2) was decreased after intubation(P<0.05).The incidence of SpO_(2)<95%in group M was higher than that in group T during intubation(P<0.05),and the lowest SpO_(2) in group M was lower than that in group T during intubation(P<0.05).There were no significant differences in adverse events between the two groups.Conclusion The study suggests that THRIVE can significantly reduce the incidence of O_(2) desaturation and carbon dioxide retention without increasing ventilation-related complication compared with conventional oxygenation during awake fiberoptic nasotracheal intubation in patients with cervical fracture.