全身麻醉下保留自主呼吸与喉罩机械通气对气管镜诊疗患者血气分析、炎症及应激反应的影响

Effectsof preserving autonomous respiration under general anesthesia versus using laryngeal mask airway mechanical ventilation on blood gas analysis,inflammation,and stress response in patients undergoing tracheal endoscopy

目的分析保留自主呼吸全身麻醉和机械通气喉罩全麻下气管镜诊疗患者血气分析、炎症及应激反应的影响。方法抽取江西省赣州市第五人民医院行气管镜诊疗的患者为主要研究对象,采集时间为2022年1月至2023年6月,共纳入80例符合入选标准的患者进行研究,按随机数字表法以1∶1比例均分为对照组和研究组,其中40例患者给予保留自主呼吸全身麻醉,归为对照组,另40例患者给予机械通气喉罩全麻,归为观察组,记录两组麻醉效果,并分析麻醉前(T0)、麻醉即刻(T_(1))、纤支镜检查开始时(T_(2))、检查结束时(T_(3))血气分析[动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))、动脉血氧饱和度(SaO_(2))]、炎症因子水平[白介素-6(IL-6)、降钙素原(PCT)、肿瘤坏死因子-α(TNF-α)]及应激反应[皮质醇(Cor)、血管紧张素I(Ang-I)]的变化,并随访统计各组并发症发生情况。结果观察组麻醉优良率为95.00%,对照组麻醉优良率为85.00%,两组相比差异有统计学意义(P<0.05);麻醉前(T0)两组PaO_(2)、PaCO_(2)、SaO_(2)、IL-6、PCT、TNF-α、Cor、Ang-I比较无明显统计学意义(P>0.05),在麻醉即刻(T_(1))、纤支镜检查开始时(T_(2))PaO_(2)、SaO、PaCO_(2)、IL-6、PCT、TNF-α、Cor、Ang-I较麻醉前(T0)无明显变化(P>0.05),但检查结束时(T_(3))相比,观察组患者上述指标与同期对照组比较差异有统计学意义(P<0.05);治疗期间随访调查两组并发症发生情况,发现两组并发症发生率相比,无明显统计学意义(P>0.05)。结论通过对比保留自主呼吸全身麻醉和机械通气喉罩全麻的临床效果,可发现二者用于纤维支气管镜诊疗中是可行的,但后者对患者血气指标、炎症及应激反应的影响较小,保证麻醉效果的同时还能有一定的安全性,有很好的应用价值。

Objective To analyze the effects of preserving autonomous respiration under general anesthesia and mechanical ventilation with laryngeal mask airway anesthesia on blood gas analysis,inflammation,and stress response in patients undergoing tracheal endoscopy.Methods Patients undergoing tracheal endoscopy at the Fifth People’s Hospital of Ganzhou City,Jiangxi Province,were selected as the main research subjects.The data collection period was from January 2022 to June 2023.A total of 80 patients who met the inclusion criteria were included in the study.According to the random number table method,they were evenly divided into control group and study group in a 1∶1 ratio.Among them,40 patients received general anesthesia with preservation of autonomous respiration and were classified into the control group,while another 40 patients received laryngeal mask airway anesthesia with mechanical ventilation and were classified into the observation group.The anesthesia effects of the two groups were recorded.Blood gas analysis[arterial oxygen partial pressure(PaO_(2)),arterial carbon dioxide partial pressure(PaCO_(2)),arterial oxygen saturation(SaO_(2))],levels of inflammatory factors[interleukin-6(IL-6),procalcitonin(PCT),tumor necrosis factor-alpha(TNF-α)],and stress response[cortisol(Cor),angiotensin-I(Ang-I)]were analyzed at different time points:before anesthesia(T0),immediately after anesthesia induction(T_(1)),at the start of fiberoptic bronchoscopy examination(T_(2)),and at the end of the examination(T_(3)).Complications occurrence was also recorded during the follow-up period.Results The anesthesia success rate in the observation group was 95.00%,while in the control group,it was 85.00%,with a statistically significant difference between the two groups(P<0.05).There were no significant differences in PaO_(2),PaCO_(2),SaO_(2),IL-6,PCT,TNF-α,Cor,and Ang-I between the two groups at T0(P>0.05).At T_(1) and T_(2),there were no significant changes in PaO_(2),PaCO_(2),SaO_(2),IL-6,PCT,TNF-α,Cor,and Ang-I compared to T0(P>0.05).However,at T_(3),compared to the control group,the observation group showed statistically significant differences in the above indicators(P<0.05).There were no significant differences in the occurrence of complications between the two groups during the treatment period(P>0.05).Conclusion By comparing the clinical effects of preserving autonomous respiration under general anesthesia and laryngeal mask airway anesthesia with mechanical ventilation,it is found that both methods are feasible for use in fiberoptic bronchoscopy examination.However,the latter has less impact on patients’blood gas parameters,inflammation,and stress response,ensuring anesthesia efficacy while maintaining a certain level of safety,thus having good application value.