CAJ | 학술논문

目的通过经气管插管对常规密闭机械通气的健康犬施行支气管镜模拟介入治疗,观察气管镜插入前后呼吸机参数及动脉血气分析的变化情况,以期寻求在常规密闭机械通气的条件下实施支气管镜介入治疗时所需要的适宜的气管通道及呼吸机参数.方法健康杂种犬10只,全麻和肌松状态下气管插管、常规密闭机械通气,稳定后将直径6.0 mm的支气管镜插入气管插管.观察换用不同口径气管插管(内径7.0 mm、7.5 mm及8.5 mm)后呼吸机参数(潮气量、吸气峰压)及动脉血气分析(pH、PaO2及PaCO2)的变化情况.结果应用直径6.0 mm的治疗型支气管镜插入气管插管内进行操作时,气管插管的内径应≥7.5 mm才不致产生过高的气道压而影响通气效果,并于术中维持较满意的pH、PaO2和PaCO2.为避免气压伤的危险,应调整呼吸机高压报警限在安全范围,允许一定程度的通气量置人不足及由此导致的一定程度的高碳酸血症.负压吸引时,随着负压吸引时间延长,会出现明显的低氧血症及进行性的CO2潴留,应注意控制负压吸引时间.减轻麻醉深度,患者恢复自主呼吸后,负压吸引对PaO2和PaCO2的影响降低.结论全麻和肌松状态下常规密闭机械通气时进行支气管镜介入治疗,选择内径7.5 mm以上的气管通道(气管插管或喉罩),可维持较满意的PaO2和PaCO2,安全可靠,是一种非常适合中国国情的支气管镜介入治疗途径,在绝大多数情况下可取代开放通气条件下的硬质支气管镜途径,不但经济实用,而且易于推广.
목적 통과경기관삽관대상규밀폐궤계통기적건강견시행지기관경모의개입치료,관찰기관경삽입전후호흡궤삼수급동맥혈기분석적변화정황,이기심구재상규밀폐궤계통기적조건하실시지기관경개입치료시소수요적괄의적기관통도급호흡궤삼수.방법 건강잡충견10지,전마화기송상태하기관삽관、상규밀폐궤계통기,은정후장직경6.0 mm적지기관경삽입기관삽관.관찰환용불동구경기관삽관(내경7.0 mm、7.5 mm급8.5 mm)후호흡궤삼수(조기량、흡기봉압)급동맥혈기분석(pH、PaO2급PaCO2)적변화정황.결과 응용직경6.0 mm적치료형지기관경삽입기관삽관내진행조작시,기관삽관적내경응≥7.5 mm재불치산생과고적기도압이영향통기효과,병우술중유지교만의적pH、PaO2화PaCO2.위피면기압상적위험,응조정호흡궤고압보경한재안전범위,윤허일정정도적통기량치인불족급유차도치적일정정도적고탄산혈증.부압흡인시,수착부압흡인시간연장,회출현명현적저양혈증급진행성적CO2저류,응주의공제부압흡인시간.감경마취심도,환자회복자주호흡후,부압흡인대PaO2화PaCO2적영향강저.결론 전마화기송상태하상규밀폐궤계통기시진행지기관경개입치료,선택내경7.5 mm이상적기관통도(기관삽관혹후조),가유지교만의적PaO2화PaCO2,안전가고,시일충비상괄합중국국정적지기관경개입치료도경,재절대다수정황하가취대개방통기조건하적경질지기관경도경,불단경제실용,이차역우추엄.
Objective In this experiment,healthy dogs were intubated with endotracheal tube,simulated interventional bronchoscopy was performed with the support of assist-control ventilation.Observations concerning the alternations of respiratory parameters and blood gas analysis were made to detect the proper tracheal passage and respiratory parameters for interventional bronchoscopy under conventional mechanical ventilation.Methods Ten healthy mongrel dogs were used in this experiment.Each dog was intubated with an endotracheal tube and mechanically ventilated.After the induction of general anesthesia and muscle relaxation,a bronchoscope (6.0 mm external diameter) was inserted into the endotracheal tube until the respiratory status was stable.Endotracheal tubes in different sizes were used,and the variations of the ventilatory parameters (tidal volume,peak inspiratory pressure) and the arterial blood gas analysis (pH,PaO2 and PaCO2 ) which correlated to the different sizes of the endotracheal tube(7.0 mm,7.5 mm and 8.5 mm internal diameter) were recorded.Results The internal diameter ofthe endotracheal tube should be no less than 7.5 mm when a 6.0 mm external diameter bronchoscope (therapeutic bronchoscope) was used,in order to prevent exceeding high airway pressure and maintain satisfied pH,PaO2 and PaCO2 during the procedure.In order to prevent barotrauma,thehigh pressure alarm setting should be within the security level,permit some extent of ventilationinadequacy and a degree of hypercapnia.Suctioning time should be controlled,as obvious hypoxemia andprogressive carbon dioxide retention may emerge as the suction prolonged.However,such alternation inblood gas analysis was not so obvious when the depth of anesthesia was alleviated to reserve spontaneousbreathing.Conclusions h is indicated that endotracheal tube larger than 7.5 mm could guarantee satisfiedPaO2 and PaCO2 during interventional hronchoscopy,which is supported by conventional mecbanicalventilation under general anethesia and muscle relaxation.The method described in this experiment isreliable and promising for actual conditions in China.In most instances,it could take tihe place of rigidbronchoscope under open ventilation hr its economical and practical benefits.