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| 不同流速经鼻湿化快速通气交换技术对老年患者全麻手术胃进气的影响 |
| Effects of transnasal humidified rapid-insufflation ventilatory exchange technology with different flow rates on gastric insufflation in elderly patients undergoing general anesthesia |
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| DOI：10.12089/jca.2025.09.004 |
| 中文关键词: 胃超声 胃窦横截面积 胃进气 经鼻湿化快速通气 老年 |
| 英文关键词: Gastric ultrasound Gastric antral cross-sectional area Gastric insufflation Transnasal humidified rapid-insufflation ventilatory exchange Aged |
| 基金项目:中国医学装备协会应用评价分会课题项目（2024CAME033） |
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| 中文摘要: |
目的：通过胃窦超声检查比较不同流速经鼻湿化快速通气（THRIVE）以及压力控制面罩通气（PCFV）对老年患者全麻手术诱导期间胃进气的影响。
方法：选择择期行全麻手术患者99例，男45例，女54例，年龄65～80岁，BMI 18.5～30.0 kg/m2，ASA Ⅰ—Ⅲ级。将患者随机分为四组：THRIVE 30 L/min组（T30组，n=24）、THRIVE 50 L/min组（T50组，n=25）、THRIVE 70 L/min组（T70组，n=25）和面罩5 L/min压力控制通气组（F组，n=25）。四组患者麻醉诱导对刺激无反应后分别接受THRIVE 30、50、70 L/min和PCFV 5 L/min，FiO2 100%给氧。于麻醉诱导前、诱导后即刻、诱导后1、2和3 min时采用超声监测仰卧位胃进气阳性（GI+）情况。记录麻醉诱导前、诱导后即刻、诱导后1、2和3 min时胃窦横截面积（CSA）、PaO2和PaCO2。记录术后恶心呕吐等不良事件的发生情况。
结果：与F组比较，诱导后3 min T30、T50组GI+发生率、CSA明显降低（P<0.05），T70组CSA明显降低（P<0.05），诱导后1、2、3 min T30组和T50组PaO2明显降低，PaCO2明显升高（P<0.05），诱导后3 min T70组PaO2明显降低，PaCO2明显升高（P<0.05）。与T70组比较，诱导后3 min T30组GI+发生率、CSA明显降低（P<0.05），T50组CSA明显降低（P<0.05），诱导后1、2、3 min T30组PaO2明显降低、PaCO2明显升高（P<0.05），诱导后1、3 min T50组PaO2明显降低（P<0.05）。与T50组比较，诱导后2、3 min T30组PaO2明显降低，诱导后1、2、3 min PaCO2明显升高（P<0.05）。四组术后恶心呕吐发生率差异无统计学意义。
结论：与传统PCFV比较，THRIVE技术用于麻醉诱导通气可降低胃进气的发生率，相较于THRIVE 30 和70 L/min，THRIVE 50 L/min在提供较好的氧合同时，胃进气的发生率最低。 |
| 英文摘要: |
Objective: To compare the effects of different flow rates of transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) and pressure-controlled face mask ventilation (PCFV) on gastric insufflation during the induction of general anesthesia in the elderly by gastric antral ultrasound.
Methods: Ninety-nine patients undergoing elective general anesthesia were selected, including 45 males and 54 females, aged 65-80 years, with a BMI of 18.5 to 30.0 kg/m2, and ASA physical status Ⅰ to Ⅲ. The patients were randomly divided into four groups: THRIVE 30 L/min group (group T30, n = 24), THRIVE 50 L/min group (group T50, n = 25), THRIVE 70 L/min group (group T70, n = 25), and PCFV 5 L/min group (group F, n = 25). The patients in the four groups who did not respond to stimulation after anesthesia induction received THRIVE at flow rates of 30, 50, and 70 L/min and PCFV at a flow rate of 5 L/min, with 100% oxygen. Ultrasound was used to monitorgastric insufflation positive (GI+) in supine patients before anesthesia induction, immediately after induction, and 1, 2, and 3 minutes after induction. The cross-sectional area (CSA) of the gastric antrum, PaO2 and PaCO2 were recorded before anesthesia induction, immediately after induction, and 1, 2, and 3 minutes after induction. The occurrences of postoperative nausea and vomiting were documented.
Results: Compared with group F, the incidence of GI+ and CSA in groups T30 and T50 were significantly reduced 3 minutes after induction (P < 0.05), CSA in group T70 was significantly reduced (P < 0.05), PaO2 significantly decreased and PaCO2 significantly increased in groups T30 and T50 1, 2, and 3 minutes after induction (P < 0.05), and PaO2 significantly decreased and PaCO2 significantly increased in group T70 3 minutes after induction (P < 0.05). Compared with group T70, the incidence of GI+ and CSA were significantly reduced in group T30 3 minutes after induction (P < 0.05), CSA was significantly reduced in group T50 (P < 0.05), PaO2 significantly decreased and PaCO2 significantly increased in group T30 1, 2, and 3 minutes after induction (P < 0.05), and PaO2 in group T50 significantly decreased 1 and 3 minutes after induction (P < 0.05). Compared with group T50, PaO2 decreased significantly 2 and 3 minutes after induction and PaCO2 significantly increased 1, 2, and 3 minutes after induction in group T30 (P < 0.05). There was no significant difference in the incidence of postoperative nausea and vomiting among the four groups.
Conclusion: Compared with traditional PCFV, the THRIVE technology can reduce the incidence of gastric insufflation during induction of general anesthesia. Compared with THRIVE 30 and 70 L/min, THRIVE 50 L/min provides superior oxygenation with the lowest incidence of gastric insufflation. |
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