CAJ | 학술논문

目的探索并评价使用喉罩或气管插管联合常规机械通气在介入治疗手术中的应用价值.方法纳入2009年7月至2010年1月收入首都医科大学附属北京天坛医院呼吸科在全身麻醉下经喉罩或气管插管联合常规机械通气条件下接受气管镜介入治疗的患者29例,其中男19例,女10例,年龄19 ～74岁,平均(47±18)岁.观察手术前后的气道压、潮气量、术中血气分析、并发症及手术时间等指标,并对影响通气效果的相关因素进行分析.结果所有患者术中一般情况稳定,通气效果满意,无严重并发症出现.气管镜插入喉罩或气管插管后,潮气量下降27.1％,峰压升高63.1％,平台压及平均压分别升高43.7％和32.4％；使用气管插管的患者操作前后峰压升高79.3％,高于使用喉罩的患者峰压升高程度(55.3％).结论全身麻醉下使用喉罩或气管插管联合常规机械通气条件下进行气管镜介入治疗安全可靠.操作过程中峰压明显增高,但整个气道的平均压力仍能保持较低水平；在使用喉罩或气管插管进行气管镜介入治疗时,应尽可能选用较大内径的喉罩或插管,以最大限度地降低气道压并避免内源性呼气末正压的产生.
목적 탐색병평개사용후조혹기관삽관연합상규궤계통기재개입치료수술중적응용개치.방법 납입2009년7월지2010년1월수입수도의과대학부속북경천단의원호흡과재전신마취하경후조혹기관삽관연합상규궤계통기조건하접수기관경개입치료적환자29례,기중남19례,녀10례,년령19 ～74세,평균(47±18)세.관찰수술전후적기도압、조기량、술중혈기분석、병발증급수술시간등지표,병대영향통기효과적상관인소진행분석.결과 소유환자술중일반정황은정,통기효과만의,무엄중병발증출현.기관경삽입후조혹기관삽관후,조기량하강27.1％,봉압승고63.1％,평태압급평균압분별승고43.7％화32.4％；사용기관삽관적환자조작전후봉압승고79.3％,고우사용후조적환자봉압승고정도(55.3％).결론 전신마취하사용후조혹기관삽관연합상규궤계통기조건하진행기관경개입치료안전가고.조작과정중봉압명현증고,단정개기도적평균압력잉능보지교저수평；재사용후조혹기관삽관진행기관경개입치료시,응진가능선용교대내경적후조혹삽관,이최대한도지강저기도압병피면내원성호기말정압적산생.
Objective To explore and evaluate the technique of performing interventional bronchoscopy by using mechanical ventilation with larynx mask or tracheal intubation under general anesthesia.Methods From July 2009 to January 2010,29 patients received interventional bronchoscopy by using mechanical ventilation with larynx mask or tracheal intubation under general anesthesia.Airway pressure and tidal volume before and after bronchoscope insertion,arterial blood gas analysis during interventional bronchoscopy,complications and operation time were recorded.The factors influencing ventilation effects were evaluated.Results All the patients' condition were kept stable during interventional bronchoscopy and no severe complications occurred.Tidal volume was reduced by 27.1％,while peak airway pressure,plateau pressure and mean airway pressure were increased by 63.1％,43.7％ and 32.4％ following insertion of the bronchoscope respectively.Patients using tracheal intubation had their peak pressure increased by 79.3％,which was higher than that of patients using larynx mask (55.3％).Conclusions Interventional bronchoscopy by using mechanical ventilation with larynx mask or tracheal intubation under general anesthesia was safe and reliable.Although peak airway pressure increased following insertion of bronchoscope,the mean airway pressure was maintained in a low level.When performing interventional bronchoscopy during mechanical ventilation,the inside diameter of larynx mask and tracheal intubation should be as large as possible to minimize airway pressure and auto-PEEP.