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经鼻咽通气管声门上机械通气在ERCP中的应用价值
The value of supraglottic mechanical ventilation via nasopharyngeal airway in ERCP
收稿日期:  
DOI:10.3969/j.issn.1673-9701.2024.19.004
关键词:  鼻咽通气管  低氧血症  声门上通气  非插管全身麻醉  经内镜逆行胰胆管造影
Key Words:
基金项目:山东省医学会镇痛镇静麻醉优化专项资金(YXH2022ZX05271)
作者单位
张林 锦州医科大学临沂市人民医院研究生培养基地麻醉科山东临沂 276000 
张宁 锦州医科大学临沂市人民医院研究生培养基地麻醉科山东临沂 276000 
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摘要:目的 探究经鼻咽通气管声门上机械通气在经内镜逆行胰胆管造影(endoscopic retrograde cholangiopancreatography,ERCP)中的应用价值。方法 选取2022年7月至12月于临沂市人民医院拟行ERCP的患者为研究对象,符合入组条件的患者根据是否为上呼吸道梗阻高危患者进行分层随机化,以1∶1的比例随机分配至对照组和实验组,每组各64例。实验组患者经鼻咽通气管声门上机械通气,对照组患者经鼻咽通气管声门上吸氧。比较两组患者的pH、动脉血二氧化碳分压(arterial partial pressure of carbon dioxide,PaCO2)、动脉血氧分压(arterial partial pressure of oxygen,PaO2)、乳酸、血糖、经皮动脉血氧饱和度(percutaneous arterial oxygen saturation,SpO2)、低氧血症和呼吸暂停发生率。结果 实验组患者麻醉诱导后SpO2下降更少(P<0.05),围手术期低氧血症和呼吸暂停发生率更低(P<0.05)。干预措施可平均降低上呼吸道梗阻高风险患者的PaCO2 7.8mmHg(1mmHg=0.133kPa)。手术结束时实验组患者的PaO2更高(P<0.05)。两组患者的pH、血糖、乳酸比较差异均无统计学意义(P>0.05)。结论 经鼻咽通气管声门上机械通气可降低麻醉诱导后SpO2下降程度和低氧血症发生率,减少呼吸暂停次数,提高手术结束时PaO2;该措施可提高上呼吸道阻塞高风险患者的围手术期通气水平,减少其CO2蓄积程度。
Abstract:Objective To explore the application value of supraglottic mechanical ventilation via nasopharyngeal airway in endoscopic retrograde cholangiopancreatography (ERCP). Methods Patients who planned to receive ERCP in Linyi People’s Hospital from July to December 2022 were selected as the study objects. Patients eligible for inclusion were stratified and randomized according to whether they were high-risk patients with upper respiratory tract obstruction, and randomly assigned to control group and experimental group at a ratio of 1 : 1, with 64 cases in each group. Patients in experimental group received supraglottic mechanical ventilation via nasopharyngeal airway, while those in control group were given oxygen via nasopharyngeal airway. The differences of pH, arterial partial pressure of carbon dioxide (PaCO2), arterial partial pressure of oxygen (PaO2), lactic acid, blood glucose, percutaneous arterial oxygen saturation (SpO2), hypoxemia and apnea between two groups were compared. Results In experimental group, the decrease of SpO2 was less (P<0.05), and the incidence of perioperative hypoxemia and apnea was lower (P<0.05). The intervention reduced PaCO2 7.8 mmHg 1mmHg=0.133kPa on average in patients at high risk of upper airway obstruction. At the end of operation, the PaO2 in experimental group was higher (P<0.05). There was no significant difference in pH, blood glucose and lactic acid between two groups (P>0.05). Conclusion Supraglottic mechanical ventilation via nasopharyneal airway can reduce the extent of SpO2 decrease following anesthesia induction and the incidence of hypoxemia, it also reduces the number of apnea and increases PaO2 at the end of operation. This approach can enhance perioperative ventilation levels and reduce perioperative CO2 accumulation in patients at high risk of upper airway obstruction.
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