机械通气下行纤维支气管镜检查的肺通气效果观察

目的:采用随机自身对照设计方法比较在机械通气条件下,置入纤维支气管镜前、后机械通气的有效性。方法:选择25例ASA评分Ⅰ~Ⅱ级,拟在全身麻醉下行下肢内固定取出术的患者,在常规诱导后插入SLIPA喉罩。检查气密性、位置满意后,通过Y型接头接呼吸机,将潮气量设为10 ml/kg,实施CMV+模式通气。记录此后连续5次呼吸的平均吸气流速、呼气流速、吸气峰压、吸气气道阻力、气道的顺应性。再经Y型接头置入纤维支气管镜至气管隆突上方约1cm处,再次记录此后连续5次呼吸的平均吸气流速、呼气流速、吸气峰压、吸气气道阻力、气道的顺应性等。结果:所有患者在置入纤支镜前、后均能获得良好的通气效果,平均吸气流速、呼气流速、吸气峰压、吸气气道阻力、气道的顺应性均无显著差异。结论:使用SLIPA喉罩并施行机械通气,可以为纤维支气管镜检查或手术提供安全、有效、长时间的通气支持。

Lung Ventilation Effects Observation in Bronchoscopy with Mechanical Ventilation

Objective：To compare the effect of mechanical ventilation before and after insertion of bronchoscopy in a randomized self-control design.Methods：Twenty-five were patients of ASA gradeⅠorⅡ,were scheduled for internal fixation dislodgment surgery in lower limb under general anesthesia.After the routine intravenous anesthesia induction,the streamlined liner of the pharynx airway（SLIPA）were inserted.To connect respirator by a Y-shaped joint after checking the airway seal and location is satisfactory.The indicators of five continuous breaths were measured after CMV＋ ventilation strategy with 10ml/kg tidal volume were enforced.Then bronchoscopy were inserted and situated 1cm above the tracheal carina with SLIPA for the guide by the Y-shaped joint.The mean expired flow,inspired flow,peak inspiratory pressure,airway resistance and airway compliance of five continuous breaths were measured again.Results：Adequate ventilation were obtained in all patients before and after insertion of SLIPA,The mean expired flow,inspired flow,peak inspiratory pressure,airway resistance and airway compliance were not significantly different.Conclusion：Mechanical ventilation using SLIPA is safe and effective in bronchoscopy or surgery for long time.