摘要
目的探讨硬质支气管镜(硬镜)操作过程中气道封闭与否对患者并发症的影响。方法本研究为观察性研究。计算机检索PubMed、The Cochrane Library、中国知网、万方数据库、NSTL,检索关键词:硬质支气管镜、硬镜、正压通气、口腔填塞、rigid bronchoscopy、oral tamponade、positive airway pressure,同时手工检索纳入文献的参考文献。共纳入12项临床研究,总样本量10059例(气道封闭组4640例,对照组5419例)。气道封闭组采用口腔填塞纱布或面罩封闭气道,对照组采用常规硬镜操作。观察2组术中低氧血症(血氧饱和度下降至90%以下并持续30 s以上)、出血(≥50 ml)、气道损伤或气胸、牙齿松动或脱落、心律失常的发生情况。结果在硬镜操作过程中,气道封闭组出现低氧血症的比例低于对照组[1.96%(91/4640)比6.88%(373/5419),χ^(2)=148.32,P<0.001],单次术中出血量≥50 ml的比例低于对照组[0.28%(13/4640)比1.77%(96/5419),χ^(2)=52.01,P<0.001],出现气道损伤或气胸的比例低于对照组[0.26%(12/4640)比0.61%(33/5419),χ^(2)=6.80,P=0.009],出现牙齿松动或脱落的比例低于对照组[0%(0/4640)比0.17%(9/5419),P=0.004],2组出现心律失常的比例差异无统计学意义[0.09%(4/4640)比0.24%(13/5419),χ^(2)=2.46,P=0.117]。结论进行硬镜操作时给予封闭气道措施后,低氧血症、术中出血、气道损伤或气胸、牙齿松动或脱落的发生率较低,但对术中心律失常的发生无显著影响。
ObjectiveTo investigate the effect of airway occlusion during rigid bronchoscopy on the complications.MethodsThis was an observational study.Relevant articles were searched in the PubMed,The Cochrane Library,China National Knowledge Infrastructure,Wanfang Database,and National Science and Technology Library(NSTL)using the key words as follows:rigid bronchoscopy,rigid lens,positive pressure ventilation,and oral tamponade both in Chinese and English languages.Citations of eligible articles were manually reviewed.A total of 12 clinical studies were included,with a total sample size of 10059 cases(4640 cases in the airway occlusion group and 5419 cases in the control group).The airway closure group closed the airway with oral packing gauze or mask,and the control group used conventional hard lens operation.The occurrences of intraoperative hypoxemia(SpO 2<90%for 30 seconds),bleeding(≥50 ml),airway injury or pneumothorax,tooth loosening or loss,and arrhythmia were observed.ResultDuring the procedure of rigid bronchoscopy,the proportion of hypoxemia(1.96%[91/4640]vs 6.88%[373/5419],χ^(2)=148.32,P<0.001),bleeding amount≥50 ml in a single operation(0.28%[13/4640]vs 1.77%[96/5419],χ^(2)=52.01,P<0.001),airway damage or pneumothorax(0.26%[12/4640]vs 0.61%[33/5419],χ^(2)=6.80,P=0.009),and loose or fallen teeth(0%[0/4640]vs 0.17%[9/5419],P=0.004)was significantly lower in the airway occlusion group than the control group.There was no significant difference in the proportion of arrhythmia between the two groups(0.09%[4/4640]vs 0.24%[13/5419],χ^(2)=2.46,P=0.117).ConclusionAfter appropriate measures to close the airway during rigid bronchoscopy can result in a low incidence of hypoxemia,bleeding,injury and pneumothorax,and tooth loosening or loss,while it barely influences intraoperative arrhythmia.
作者
罗兰
郑远江
金晓迪
李珊珊
叶贤伟
Luo Lan;Zheng Yuanjiang;Jin Xiaodi;Li Shanshan;Ye Xianwei(School of Clinical Medicine,Guizhou Medical University,Guiyang 550004,China;Department of Pulmonary and Critical Care Medicine,Guizhou Provincial People's Hospital,Guiyang 550002,China)
出处
《国际呼吸杂志》
2025年第5期424-429,共6页
International Journal of Respiration
基金
中国医学科学院中央级公益性科研院所基本科研业务费专项(2019PT320003)。
