Effect of deep muscle relaxation on oxygenation of jet ventilation during rigid bronchoscopy procedures
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摘要:
目的 硬质支气管镜手术中喷射通气最佳条件仍未明确，本研究探讨硬质支气管镜术中深度肌松对喷射通气氧合效果的影响。 方法 选择2021年1月—2022年12月宁波大学附属人民医院择期行全身麻醉下经硬质支气管镜中央气道病变治疗患者68例，采用随机数字表法分为2组：深度肌松组(D组，34例)和中度肌松组(M组，34例)。患者全麻诱导后插入硬质支气管镜行喷射通气，M组采用4个成串刺激(TOF)测定肌松深度，维持TOF计数为1~2；D组采用强直刺激后单刺激肌颤搐计数(PTC)测定肌松深度，维持PTC在1~2。术毕阿托品、新斯的明拮抗残余肌松。 结果 2组患者整体手术时间、手术时间比较，差异无统计学意义(均P>0.05)；D组麻醉时间小于M组(P < 0.01)；D组苏醒时间、拔管时间、肌松剂用量大于M组(均P < 0.05)；D组患者术中缺氧事件[(2.7±0.6)次/人]、采取缺氧干预措施(27/33)、手术暂停时间[(7.6±3.5)min]均小于M组[(8.8±2.6)次/人、33/33、(19.3±5.6)min]，且术者满意度评分[(9.4±0.5)分]高于M组[(6.2±1.5)分，P < 0.05]；D组动脉血氧分压在喷射通气15、30 min时间点高于M组(均P < 0.05)；D组术后咽喉疼痛例数(18/33)少于M组(26/33，P=0.037)。 结论 硬质支气管镜治疗术中应用深度肌松可以改善喷射通气的氧合效果，减少缺氧事件、手术暂停时间及麻醉时间，提高术者满意度，对整体手术时间无影响。 Abstract:Objective The optimal condition of jet ventilation during rigid bronchoscopy is still unclear. This study explores the effect of deep muscle relaxation during rigid bronchoscopy on the oxygenation effect of jet ventilation. Methods Sixty-eight patients who received selective treatment for central airway lesions under general anesthesia by rigid bronchoscopy from January 2021 to December 2022 in the Affiliated People's Hospital of Ningbo University were divided into deep muscle relaxation group (group D, n=34) and moderate muscle relaxation group (group M, n=34) by random number table method. After induction of general anesthesia, the patients were inserted rigid bronchoscopy for jet ventilation. Train of four (TOF) stimulation was used to measure the depth of muscle relaxation in group M, and the TOF count was maintained at 1-2. In Group D, the depth of muscle relaxation was measured by post tetanic count (PTC), and the PTC was maintained at 1-2. After operation, atropine and neostigmine antagonized residual muscle relaxation. Results There were no significant differences in the overall operation time and operation time between the two groups (all P>0.05). The anesthesia time in group D was shorter than that in group M (P < 0.01). The recovery time, extubation time and muscle relaxant dosage in group D were longer than those in group M (all P < 0.05). The intraoperative hypoxic events [(2.7±0.6) times/person], the use of hypoxic intervention measures (27/33) and the operation suspension time [(7.6±3.5) min] in group D were lower than those in group M [(8.8±2.6) times/person, 33/33, (19.3±5.6) min], and the surgeon satisfaction score in group D [(9.4±0.5) points] was higher than that in group M [(6.2±1.5) points, P < 0.05]. The arterial oxygen partial pressure in group D was higher than that in group M at 15 and 30 min of jet ventilation (all P < 0.05). The number of cases with postoperative sore throat in group D (18/33) was lower than that in group M (26/33, P=0.037). Conclusion The application of deep muscle relaxation in rigid bronchoscopy procedures can improve the oxygenation effect of jet ventilation, reduce incidence of hypoxemia, operation suspension time and anesthesia time, improve the satisfaction of operators, and has no effect on the total operation time. -
Key words:
- Deep muscle relaxation /
- Rigid bronchoscopy /
- Jet ventilation /
- Oxygenation
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表 1 2组中央气道病变患者一般资料比较
Table 1. Comparison of general characteristics between two groups of patients with central airway lesions
组别 例数 性别(女性/男性，例) 年龄(x±s，岁) 身高(x±s，cm) 体重(x±s，kg) ASA分级(Ⅰ/Ⅱ/Ⅲ，例) FEV1/FVC (x±s，%) 氧分压(x±s，mmHg) D组 33 9/24 62±5 168±6 57±6 0/9/24 85±4 81±5 M组 33 11/22 64±6 169±5 59±7 1/10/22 83±5 83±6 统计量 0.287a 1.471b 0.736b 1.868b 0.481c 1.794b 1.471b P值 0.592 0.146 0.465 0.066 0.631 0.078 0.146 注：a为χ2值，b为t值，c为Z值。1 mmHg=0.133 kPa。 
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表 2 2组中央气道病变患者麻醉手术情况比较(x±s)
Table 2. Comparison of anesthetic surgical conditions between two groups of patients with central airway lesions (x±s)
组别 例数 整体手术时间(min) 手术时间(min) 麻醉时间(min) 苏醒时间(min) 拔管时间(min) 肌松剂用量(mg) 术者满意度评分(分) D组 33 147±20 93±15 101±9 25±7 30±6 32±5 9.4±0.5 M组 33 152±22 97±17 117±13 17±5 21±4 22±4 6.2±1.5 t值 0.996 1.014 5.729 5.342 7.170 8.972 11.626 P值 0.338 0.315 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001
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表 3 2组中央气道病变患者缺氧情况、干预措施及手术暂停时间比较
Table 3. Comparison of hypoxia, interventions and surgical pause time in patients with central airway lesions between two groups
组别 例数 缺氧事件(x±s，次/人) 最低SpO2 (x±s，%) 缺氧例数(例) 干预措施(例) 暂停时间(x±s，min) 轻度缺氧 严重缺氧 人工通气 紧闭通气 气管插管 D组 33 2.7±0.6 86±5 26 1 24 3 0 7.6±3.5 M组 33 8.8±2.6 83±6 31 2 27 5 1 19.3±5.6 统计量 13.133a 2.207a 6.919b 7.693b 10.178a P值 < 0.001 0.031 0.024 0.034 < 0.001 注：a为t值，b为χ2值。
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表 4 2组中央气道病变患者动脉血气分析检测结果比较(x±s，mmHg)
Table 4. Comparison of arterial blood gas analysis results between two groups of patients with central airway disease (x±s, mmHg)
组别 例数 氧分压 二氧化碳分压 T0 T1 T2 T3 T0 T1 T2 T3 D组 33 82±5 83±7 82±6 104±17 42±4 48±6 47±7 42±5 M组 33 84±6 71±6 69±5 97±15 40±5 49±6 49±6 44±6 t值 1.471 7.477 9.562 1.774 1.794 0.736 1.246 1.471 P值 0.146 < 0.001 < 0.001 0.081 0.078 0.465 0.217 0.146
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表 5 2组中央气道病变患者术后并发症及住院时间比较
Table 5. Comparison of postoperative complications and length of hospital stay between two groups of patients with central airway disease
组别 例数 咽喉疼痛(例) 气压伤(例) 呼吸衰竭(例) 再次手术(例) 住院时间(x±s，d) D组 33 18 1 1 0 8.7±3.1 M组 33 26 0 2 1 9.2±3.6 统计量 4.364a 0.605c P值 0.037 0.999b 0.999b 0.999b 0.548 注：a为χ2值, b为使用Fisher精确检验，c为t值。
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