腹腔镜胆囊切除术中经鼻湿化快速充气交换通气技术对全身麻醉诱导窒息氧合期胃扩张及术后胃肠功能的影响

Effect of transnasal humidified rapid-insufflation ventilatory exchange on gastric dilatation and postoperative gastrointestinal function during the oxygenation period of apnea induced by general anesthesia in patients with laparoscopic cholecystectomy

目的探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)全身麻醉诱导期经鼻湿化快速充气交换通气(transnasal humidified rapid-insufflation ventilatory exchange,THRIVE)技术对患者胃扩张及术后胃肠功能的影响。方法选取2021年2—10月长江大学附属第一医院静吸复合全身麻醉下行择期LC的患者60例,根据麻醉诱导期通气策略不同,利用SPSS软件随机数字生成程序简单随机化分为THRIVE组(T组)和密闭面罩加压通气组(M组),每组30例。面罩纯氧去氮至呼出氧浓度达90%后,T组经鼻加湿加热高流量给氧,M组密闭面罩加压通气,全身麻醉诱导。观察并记录患者的一般资料,给氧去氮至呼出氧浓度达到90%(T_(1))和气管插管完成时(T_(2))超声下测量胃窦横截面积,术中直视下胃扩张情况,术中用药及输液,术后恶心呕吐(postoperative nausea and vomiting,PONV)及术后胃肠功能状况。结果在麻醉诱导气管插管完成时,两组都能保证充足的氧供,SpO_(2)均>90%。T_(2)时,T组呼气末二氧化碳分压(partial pressure of end-tidal carbon dioxide,PETCO_(2))大于M组[(35.73±2.89)mmHg比(31.53±3.75)mmHg,1 mmHg=0.133 kPa],超声下胃窦横截面积小于M组[(4.56±0.90)cm2比(5.71±1.25)cm2],差异均有统计学意义(P<0.001)。T组腹腔镜直视下胃扩张程度和PONV程度均好于M组(胃扩张程度:T组1级28例、2级2例、3级0例、4级0例,M组1级16例、2级8例、3级5例、4级1例;PONV程度:T组无恶心呕吐27例、轻度2例、中度1例,M组无恶心呕吐19例、轻度10例、中度1例),差异有统计学意义(P<0.05)。结论THRIVE技术能确保患者在全身麻醉诱导期有效氧合,还能降低诱导期胃扩张的发生和PONV,且不影响胃肠功能恢复。

Objective To investigate the effect of transnasal humidified rapid-insufflation ventilatory exchange(THRIVE)on gastric dilatation and postoperative gastrointestinal function in patients with laparoscopic cholecystectomy(LC)undergoing induction of general anesthesia.Methods From February to October 2021,60 patients received LC under intravenous and inhalation combined with general anesthesia in the First Affiliated Hospital of Yangtze University were selected.According to the different ventilation strategies during the anesthesia induction period,SPSS software was used to randomly divide the patients into the THRIVE group(group T)and the closed mask pressurized ventilation group(group M),with 30 patients in each group.After the concentration of exhaled oxygen reached 90%,group T received THRIVE,group M received pressurized ventilation with a closed mask,and general anesthesia was induced.General data of the patients were recorded,the cross-sectional gastric antral area was measured under ultrasound when the concentration of exhaled oxygen reached 90%(T_(1))after oxygen was given and nitrogen was removed and when the tracheal intubation was completed successfully(T_(2)).Perioperation gastric dilation under laparoscopy,intraoperative medication and infusion,postoperative nausea and vomiting(PONV)and postoperative gastrointestinal function were observed.Results When anesthesia induction tracheal intubation was completed,both groups ensured adequate oxygen supply,SpO_(2)>90%.At T_(2),the partial pressure of end-tidal carbon dioxide(PETCO_(2))of the group T was larger than that of the group M[(35.73±2.89)mmHg vs.(31.53±3.75)mmHg,1 mmHg=0.133 k Pa],and the cross-sectional gastric antral area was less than that of the group M[(4.56±0.90)cm2vs.(5.71±1.25)cm2],with statistically significant differences(P<0.001).The degree of gastric dilation and PONV under laparoscopic of the group T were better than those of the group M(degree of gastric dilation:28 cases of grade 1,two cases of grade 2,no cases of grade 3 and no cases of grade 4 in group T,16 cases of grade 1,eight cases of grade 2,five cases of grade3 and one case of grade 4 in group M;PONV degree:27 cases of no nausea and vomiting,two cases of mild and one case of moderate in group T,19 cases of no nausea and vomiting,10 cases of mild and one case of moderate in group M),the differences were statistically significant(P<0.05).Conclusions THRIVE can ensure the effective oxygenation of patients during the induction period of general anesthesia,reduce the occurrence of gastric dilatation and PONV,and does not affect the recovery of gastrointestinal function.