叠加高频喷射通气与间歇性正压通气在鼻内窥镜鼻窦手术中的应用

Application of high frequency jet ventilation and intermittent positive pressure ventilation in endoscopic sinus surgery

目的比较叠加高频喷射通气(SHFJV)与间歇性正压通气(IPPV)对功能性内窥镜鼻窦手术(FESS)患者外科术野质量的影响。方法选择行FESS的患者80例,男49例,女31例,年龄18~64岁,BMI 19~30 kg/m^(2),ASAⅠ—Ⅲ级。采用随机数字表法将患者分为两组:SHFJV组(SH组)和IPPV组(IP组),每组40例。记录术中晶体液、胶体液、红细胞(RBC)、新鲜冰冻血浆(FFP)、出血量、尿量、血管活性药(硝酸甘油、去甲肾上腺素)用量和手术时间。手术期间每15分钟记录HR、MAP、心脏指数(CI)、心率血压乘积(RPP)和外科术野质量评分,记算平均值。记录插管即刻、鼻内窥镜置入后1、2 h、术毕时pH、PaO_(2)、PaCO_(2)、SpO_(2)、乳酸(Lac)、碱剩余(BE)、Hb。记录术后3 d内寒战、低血压、恶心呕吐、发热、睡眠障碍、手术部位感染和肺部感染发生情况。结果与IP组比较,SH组晶体液、胶体液、RBC输注量、出血量、RPP明显减少(P<0.01),外科术野质量评分明显降低(P<0.01),置入后1、2 h pH明显降低,PaCO_(2)、BE和Hb明显升高(P<0.05),术毕时PaCO_(2)、BE和Hb明显升高(P<0.05),术后3 d内低血压、恶心呕吐发生率明显降低(P<0.05)。两组寒战、发热、睡眠障碍和肺部感染发生率差异无统计学意义。两组无一例手术部位感染。结论与间歇性正压通气比较,叠加高频喷射通气可减少功能性内窥镜鼻窦手术患者术中出血量,提高外科术野质量,减少术后低血压、恶心呕吐等并发症,可安全有效地用于临床。

Objective To compare the effects of superposition high-frequency jet ventilation(SHFJV)and intermittent positive pressure ventilation(IPPV)on surgical field quality in patients undergoing functional endoscopic sinus surgery(FESS).Methods Eighty patients,49 males and 31 females,aged 18-64 years,BMI 19-30 kg/m^(2),ASA physical statusⅠ-Ⅲ,who underwent FESS were selected.The patients were randomly divided into SHFJV group(group SH)and IPPV group(group IP),40 cases in each group.Intraoperative crystalloid fluid,colloidal fluid,red blood cell(RBC),fresh frozen plasma(FFP),blood loss,urine volume,vasoactive drugs(nitroglycerin,norepinephrine)during maintenance,operation time were recorded.HR,MAP,cardiac index(CI),heart rate and blood pressure product(RPP),and surgical field quality scores were recorded every 15 minutes during surgery.pH,PaO_(2),PaCO_(2),SpO_(2),lactate(Lac),alkali surplus(BE),and Hb were recorded immediately after intubation,1 hour,2 hours after nasal endoscopy insertion,and at the end of operation.The incidence of chills,hypotension,nausea and vomiting,fever,sleep disorders,surgical site infection and pulmonary infection within 3 days after operation were recorded.Results Compared with group IP,the amount of blood loss,crystalloid fluid,colloid fluid,RBC infusion volume and RPP in group SH were significantly decreased(P<0.01),the surgical field quality score was significantly decreased(P<0.01),the pH was significantly decreased 1 hour,2 hours after implantation,and the PaCO_(2),BE,and Hb were significantly increased(P<0.05).PaCO_(2),BE,and Hb were significantly increased at the end of operation(P<0.05),and the incidence of hypotension,nausea and vomiting were significantly decreased within 3 days after operation(P<0.05).There was no significant difference in the incidence of chills,fever,sleep disturbance and pulmonary infection between the two groups.There was no infection of surgical incision in the two groups.ConclusionCompared with intermittent positive pressure ventilation,superposition high-frequency jet ventilation can reduce intraoperative blood loss,improve surgical field quality,reduce postoperative complications such as hypotension,nausea and vomiting in patients undergoing functional endoscopic sinus surgery,which is safe and effective in clinical practice.