经鼻湿化快速充气通气交换技术在住院医师规范化培训纤维支气管镜引导气管插管中的应用

Application of transnasal humidified rapid-insufflation ventilatory exchange in fiberoptic bronchoscope guided endotracheal intubation of residential training students

目的评价经鼻湿化快速充气通气交换技术(THRIVE)在住院医师规范化培训纤维支气管镜(纤支镜)引导气管插管中的应用效果。方法选择非麻醉专业学员10名,依据插管期间供氧方式的不同随机分为两组:THRIVE组(T组)和对照组(C组),每组5名。每名学员需完成经纤支镜引导气管插管随机病例20例,共200例患者,男108例,女92例,年龄18~64岁,BMI 18~24 kg/m^(2),ASAⅠ或Ⅱ级。两组学员独立完成经纤支镜气管插管操作,插管期间T组使用THRIVE装置以FiO_(2)100%给氧,70 L/min,C组移开面罩进行插管。记录每例患者插管成功与否。绘制两组学员学习曲线,用累积和(CUSUM)方法建立学习曲线,运用累积和分析法算出掌握相应插管技术所需要的最小例数。记录学习曲线平台期前SpO_(2)<90%的例数,气道建立过程中是否有鼻出血、口咽腔处损伤、牙齿损伤、心律失常、喉痉挛等明显通气及插管相关不良反应。结果与C组比较,T组学员掌握纤支镜引导气管插管操作所需的最少插管例数明显减少(P<0.05),学习曲线平台期前SpO_(2)<90%发生例数明显减少(P<0.05)。两组在围插管期均未观察到明显通气及插管并发症。结论住院医师规范化培训行纤支镜引导气管插管的无呼吸氧合期应用THRIVE通气可明显改善学习曲线,降低围插管期患者低氧血症的发生率,且不增加通气相关并发症,适合临床推广应用。

Objective To assess the effect of transnasal humidified rapid-insufflation ventilatory exchange(THRIVE)during endotracheal intubation by using a fiberoptic bronchoscope in residential students training.Methods Ten non anesthesia students were randomly divided into two growps:THRIVE group(group T)and control group(group C)according to the different ways of oxygen supply during intubation,5 students in each group.Each student needed to complete 20 cases at random.A total of 200 patients were enrolled,including 108 males and 92 females,aged 18-64 years,BMI 18-24 kg/m^(2),ASA physical statusⅠorⅡ.Patients in the two groups were pre-oxygenated with mask and induced by general anesthesia.The students would independently complete endotracheal intubation of fiberoptic bronchoscope.During the intubation,THRIVE was given at a flow rate of 70 L/min with 100%oxygen concentration in group T,and the mask was removed in group C.Whether each patient was successfully intubated were recorded.The learning curve of the two groups of students was drown,the learning curve was established using CUSUM method,and the minimum number of cases required to master the corresponding intubation technology was calculated using CUSUM analysis method.The incidence of SpO_(2)<90%before the learning curve platform,the complications of ventilation and intubation such as epistaxis,oropharyngeal injury,tooth injury,arrhythmia and laryngospasm were recorded during airway establishment.Results Compared with group C,the minimum number of intubation cases necessary to master fiberbronchoscope guided endotracheal intubation in group T could be significantly decreased(P<0.05),the incidence of SpO_(2)<90%before the learning curve platform in group T was significantly decreased(P<0.05).There was no ventilation and intubation complications in both groups of patients.Conclusion The use of THRIVE could significantly shortens students learning curves during the asphyxia oxygenation phase of tracheal intubation fiberoptic guided bronchoscopy,decreases the incidence of hypoxemia in patients during the perioperative intubation phase,and dose not increase ventilation-related complications,which is suitable for clinical application.