不同功率高频电刀或氩气刀诱发燃爆的氧浓度阈值

Oxygen concentration threshold for explosion induced by high-frequency electric knife or argon knife at different energies

目的:确定不同功率高频电刀或氩气刀诱发燃爆的氧浓度阈值。方法:①离体实验:新鲜猪肺10副,放置于自制玻璃箱内,高频电刀或氩气刀功率分别设定为30、50 W,对气管内富含脂肪组织区域及平滑肌组织区域进行烧灼。起始氧浓度20%,逐步升高氧浓度,调节梯度为5%,直至氧浓度80%终止。每个浓度下每副标本激发10次,记录发生燃爆的次数。只要发生1次燃爆即认为该浓度可诱发燃爆,激发燃爆的最低氧浓度即为阈值。②气管镜介入治疗患者气道内氧浓度测定:选择择期行气管镜下冷冻治疗患者30例,吸入氧浓度从100%开始下调,氧下调至50%即终止,降低梯度为10%,采用AIRVO 2经鼻高流量吸氧设备测定气道内氧浓度。气道内氧浓度与吸入氧浓度进行ICC一致性分析。结果:在富含脂肪组织中,高频电刀功率30 W时发生燃爆的氧浓度阈值为70%,功率50 W时发生燃爆的氧浓度阈值为65%;氩气刀功率30 W时发生燃爆的氧浓度阈值为35%,功率50 W时发生燃爆的氧浓度阈值为30%。在平滑肌组织中,高频电刀、氩气刀功率30或50 W时各氧浓度下均未发生燃爆,阈值为80%以上。气管内氧浓度与吸入氧浓度一致性中等(ICC值0.722,95%CI 0.537~0.850,P<0.001)。结论:在平滑肌组织中,使用高频电刀和氩气刀在氧浓度低于80%时不易发生燃爆。在富含脂肪组织中,高频电刀30 W时氧浓度低于70%及50 W时氧浓度低于65%不易发生燃爆;氩气刀30 W时氧浓度低于35%及50 W时氧浓度低于30%不易发生燃爆。气管内氧浓度阈值可用吸入气氧浓度确定。

Objective To determine the oxygen concentration threshold for explosion induced by high-frequency electric knife or argon knife at different energies.Methods①In vivo experiment The smooth muscle tissue or adipose-rich tissue in 10 pairs of isolated porcine lungs and trachea was electrocauterized at 30 and 50 W with high-frequency electroknife or argon knife at different oxygen concentrations.The initial oxygen concentration was 20%,the oxygen concentration was gradually increased in increments of 5%until the oxygen concentration reached 80%.Each sample was electrocauterized 10 times at each concentration,and the number of explosion was recorded.As long as one explosion occurred,it could be considered that the concentration could induce explosion,and the minimum oxygen concentration inducing explosion was considered as the threshold.②Measurement of oxygen concentration in the airway of patients received bronchoscopic intervention Thirty patients scheduled for elective bronchoscopy with cryotherapy were selected,the oxygen concentration inhaled was reduced from 100%until 50%in decrements of 10%,and the oxygen concentration in airway was measured with the AIRVO 2 transnasal high-flow oxygen inhalation device.ICC consistency analysis was performed between the oxygen concentration in airway and oxygen concentration inhaled.Results In adipose-rich tissues,the threshold of the oxygen concentration for explosion was 70%at 30 W and 65%at 50 W when using the high-frequency electric knife;the threshold of the oxygen concentration for explosion was 35%at 30 W and 30%at 50 W when using the high-frequency argon knife.In smooth muscle tissues,no explosion occurred at each oxygen concentration when using the high-frequency electric knife and argon knife at 30 or 50 W,and the threshold value was above 80%.There was moderate consistency(ICC value 0.722,95%CI 0.537-0.850,P<0.001)between the oxygen concentration in airway and oxygen concentration inhaled.Conclusions In smooth muscle tissues,explosion is not easy to occur at oxygen concentrations below 80%when using the high-frequency electric knife or argon knife.In adipose-rich tissues,explosion is not easy to occur at oxygen concentrations less than 70%at 30 W and at oxygen concentrations less than 65%at 50 W when using the high-frequency electric knife;explosion is not easy to occur at oxygen concentrations less than 35%at 30 W and at oxygen concentrations less than 30%at 50 W when using the high-frequency argon knife.The threshold of oxygen concentrations in airway can be determined using the oxygen concentration inhaled.