摘要
目的:观察魏氏鼻咽通气道(wei nasal jet tube,WNJT)在颜面部大面积烧伤患者麻醉诱导中应用的有效性及安全性。方法:选取2021年7月至2024年5月在晋江市医院(上海市第六人民医院福建医院)行全身多处削痂植皮术的患者60例,年龄18~60岁,体质指数(body mass index,BMI)为18~29 kg/m^(2),美国麻醉医师协会(American Society of Anesthesiologists,ASA)Ⅱ或Ⅲ级,Mallampati分级Ⅰ~Ⅲ级。采用随机数字表法将患者分为2组:喷射通气组(W组)和面罩通气组(M组),每组30例。麻醉诱导前,W组患者经一侧鼻腔插入WNJT行手控常频声门上喷射通气,M组患者通过常规双手扣面罩加压给氧通气。5 min后在可视喉镜下行气管插管,分别于给氧去氮5 min自主呼吸时(T_(0))、麻醉诱导给药后1 min(T_(1))、2 min(T_(2))、3 min(T_(3))、4 min(T_(4))和5 min(即插管前即刻,T_(5))时采用超声测量膈肌波动振幅、P_(ET)CO_(2)、SpO_(2)。记录T_(0)、T_(5)时患者的PaO_(2)、PaCO_(2)。记录2组T_(0)~T_(5)时的心率(heart rate,HR)、平均动脉压(mean arterial pressure,MAP)。记录2组患者术后咽痛、颜面部或下颌角出血、胃肠胀气、鼻黏膜出血的发生情况。结果:T_(0)时2组患者膈肌波动振幅、HR、MAP、PaO_(2)、PaCO_(2)、P_(ET)CO_(2)、SpO_(2)差异无统计学意义;T_(1)~T_(5)时W组HR、MAP小于M组(P<0.05);在T_(5)时,W组患者的PaO_(2)高于M组,而PaCO_(2)、P_(ET)CO_(2)低于M组,差异有统计学意义(P<0.05),而SpO_(2)差异无统计学意义。W组颜面部或下颌角出血、术后胃肠胀气患者少于M组,差异有统计学意义(P<0.05),而术后咽痛、鼻黏膜出血患者2组比较差异无统计学意义(P>0.05)。结论:WNJT在颜面部大面积烧伤患者麻醉诱导时具有通气效果良好、安全性高、胃肠胀气、颜面部或下颌角处出血等并发症少、血流动力学更加稳定等优点,在临床麻醉工作中具有良好应用前景。
Objective:To observe the effectiveness and safety of the application of Wei nasal jet tube(WNJT)in anesthesia induction for patients with extensive facial burns.Methods:A total of 60 patients who underwent multiple systemic scab removal and skin grafting surgery in our hospital from July 2021 to July 2023 were enrolled in this study.The patients were 18-60 years of age,with a body mass index of 18-29 kg/m2,ASA II or III,and Mallampati I-III.Using a random number table method,the patients were divided into WNJT ventilation group(W group)and mask ventilation group(M group),with 30 cases in each group.Before anesthesia induction,WNJT was inserted into one side of the nasal cavity for hand controlled normal frequency supraglottic jet ventilation in group W patients,while oxygen ventilation was administered to group M patients through conventional two-hand clasped face masks.After 5 min,tracheal intubation was performed under a visual laryngoscope.The mean amplitude of diaphragm fluctuations,end expiratory carbon dioxide partial pressure(PETCO_(2)),and blood oxygen saturation(SpO_(2))measured by ultrasound were recorded during spontaneous respiration at 5 min of oxygenation and nitrogen remova(l T_(0)),as well as at 1 min(T_(1)),2 min(T_(2)),3 min(T_(3)),4 min(T_(4)),and 5 min(T_(5),immediately before intubation)of anesthetic induction.Arterial blood gas(PaO_(2) and PaCO_(2))at T_(0) and T_(5) were measured.Heart rate(HR)and mean arterial pressure(MAP)were recorded at T_(0)-T_(5) in both groups of patients.The occurrence of postoperative pharyngeal pain,facial or mandibular angle bleeding,gastrointestinal bloating,and nasal mucosal bleeding were recorded in both groups of patients.Results:At T_(0),there were no statistically significant differences in mean amplitude of diaphragm fluctuations,HR,MAP,PaO_(2),PaCO_(2),PETCO_(2),and SpO_(2) between the two groups of patients.At T_(1)-T_(5),the HR and MAP of patients in the W group were significantly lower than those in the M group(P<0.05).At T_(5),the PaO_(2) of patients in the W group was significantly higher than that in the M group,while the PaCO_(2) and PETCO_(2) were significantly lower than those in the M group(P<0.05).However,the difference in SpO_(2) was not statistically significant.The W group had less facial or mandibular angle bleeding and postoperative gastrointestinal bloating than the M group,and the differences were statistically significant(P<0.05).There were no statistically significant differences between the two groups of patients in postoperative pharyngitis and nasal mucosal bleeding(P>0.05).Conclusion:During general anesthesia induction in patients with extensive facial burns,WNJT has the advantages of good ventilation effect,high safety,less complications such as gastrointestinal bloating and facial or mandibular angle bleeding,and more stable hemodynamics.WNJT has good application prospects in clinical anesthesia.
作者
许福生
魏媛媛
王秋芬
肖剑威
刘小红
颜景佳
卢清旺
林建水
Xu Fusheng;Wei Yuanyuan;Wang Qiufen;Xiao Jianwei;Liu Xiaohong;Yan Jingjia;Lu Qingwang;Lin Jianshui(Department of Anesthesiology,Jin Jiang Municipal Hospital/Shanghai Sixth People's Hospital Fujian Campus)
出处
《重庆医科大学学报》
北大核心
2025年第11期1573-1577,共5页
Journal of Chongqing Medical University
关键词
魏氏鼻咽通气道
颜面部
大面积烧伤
麻醉诱导
Wei nasal jet tube
facial
extensive burns
general anesthesia induction
