CAJ | 학술논문

目的：评价面罩双水平气道正压通气应用于输尿管软镜手术中的通气效果。方法选择美国麻醉医师协会（ASA）Ⅰ～Ⅱ级拟在输尿管软镜下行钬激光碎石手术的患者30例，用丙泊酚、舒芬太尼、顺式阿曲库铵麻醉诱导，手控辅助呼吸直到患者自主呼吸消失，BestFitTM呼吸面罩连接呼吸机行双水平气道正压通气（BiPAP），记录麻醉前（T1）、面罩通气5 min（T2）、手术结束（T3）和去除面罩自主呼吸5 min（T4）4个时间点的脉搏血氧饱和度（SpO2）并作血气分析，记录T2和T3时点的气道峰压（Ppeak）、分钟通气量（MV）、肺顺应性（Cdyn）、呼气末二氧化碳分压（PETCO2）数值。结果4个时间点的动脉血氧分压（PaO2）、动脉血二氧化碳分压（PaCO2）、pH值和SpO2都在正常范围，T2和T3的PaO2明显高于T1和T4（P<0.05），术中面罩BiPAP时T2和T3的Ppeak、MV、Cdyn和PETCO2比较差异无统计学意义（P＞0.05）。结论面罩双水平气道正压通气下行输尿管软镜术能保持良好通气效果，是一种安全有效的麻醉方法。
목적：평개면조쌍수평기도정압통기응용우수뇨관연경수술중적통기효과。방법선택미국마취의사협회（ASA）Ⅰ～Ⅱ급의재수뇨관연경하행화격광쇄석수술적환자30례，용병박분、서분태니、순식아곡고안마취유도，수공보조호흡직도환자자주호흡소실，BestFitTM호흡면조련접호흡궤행쌍수평기도정압통기（BiPAP），기록마취전（T1）、면조통기5 min（T2）、수술결속（T3）화거제면조자주호흡5 min（T4）4개시간점적맥박혈양포화도（SpO2）병작혈기분석，기록T2화T3시점적기도봉압（Ppeak）、분종통기량（MV）、폐순응성（Cdyn）、호기말이양화탄분압（PETCO2）수치。결과4개시간점적동맥혈양분압（PaO2）、동맥혈이양화탄분압（PaCO2）、pH치화SpO2도재정상범위，T2화T3적PaO2명현고우T1화T4（P<0.05），술중면조BiPAP시T2화T3적Ppeak、MV、Cdyn화PETCO2비교차이무통계학의의（P＞0.05）。결론면조쌍수평기도정압통기하행수뇨관연경술능보지량호통기효과，시일충안전유효적마취방법。
Objective To evaluate the ventilation effects of mask bi-level positive airway pressure ventilation for flexible ureteroscopy. Methods Thirty ASAⅠ-Ⅱ patients scheduled for holmium laser lithotripsy were enrolled. General anesthesia was induced with propofol and sufentanil, and the patients were ventilated by manual assisted maneuver till cease of spontaneous respiration, then BestFitTM mask was connected and bi-level positive airway pressure ventilation performed. Recorded measures included SpO2 and arterial blood gases at the time points of instantly before anesthesia (T1), 5 minutes after bi-level positive airway pressure ventilation(T2), instantly after procedure(T3) and 5 minutes after mask removal and spontaneous respiration (T4). Peak airway pressure (Ppeak), minute volume (MV), dynamic compliance (Cdyn), end-tidal pressure of carbon dioxide (PETCO2) at T2 and T3 were also recorded. Results PaO2, PaCO2, pH and SpO2 at all time points were all within normal range, and PaO2 at T2 and T3 were apparently higher than those at T1 and T4(P<0.05). During mask bi-level positive airway pressure ventilation, Ppeak, MV, Cdyn and PETCO2 at T2 and T3 were similar(P>0.05). Conclusion It is safe and effective to apply bi-level positive airway pressure ventilation via mask for flexible ureteroscopy under general anesthesia.