摘要
目的 探讨俯卧位气管插管在经内镜逆行性胰胆管造影诊疗术(ERCP)高龄患者中的可行性及呼气末正压通气对肺的保护作用.方法 选取560例ERCP手术高龄患者,采用随机数字表法分为观察组和对照组,每组280例.观察组左侧俯卧,摆好体位后诱导插管.对照组仰卧位诱导插管,插管完成后调整为左侧俯卧位.全麻诱导后,可视喉镜下置入气管导管,进行机械通气.记录张口度、插管时间、插管成功率、插管损伤、摆体位并发症和手术时间及诱导前、气管插管时、摆体位时、术中和术后的平均动脉压(MAP)、心率(HR)及呼气末二氧化碳分压(PETCO2),采用数字X线分析肺不张、气胸等肺部并发症情况.结果 观察组和对照组在张口度、插管时间、插管成功率、插管损伤、手术时间、肺部并发症及诱导前、气管插管时、术中、术后的MAP、HP和PETCO2差异无统计学意义(P＞0.05).观察组摆体位时MAP波动较小及摆体位并发症发生率低(P＜0.05).结论 ERCP高龄患者俯卧位下气管插管是可行的,并发症少,呼气末正压通气模式对高龄患者有一定的肺保护作用.
Abstract
Objective To explore the feasibility of prone position tracheal intubation in elderly patients undergoing endoscopic retrograde cholangiopancreatography(ERCP)and the protective effect of positive end expiratory pressure ventilation on the lungs.Methods A total of 560 elderly patients undergoing ERCP surgery were selected and divided into an observation group and control group using a random number table method,with 280 cases in each group.The observation group was prone on the left side,and anesthesia induction and endotracheal intubation were performed after positioning.The control group underwent endotracheal intubation after anesthesia induction in the supine position,and was adjusted to the left prone position after the intubation completed.After induction of general anesthesia,a tracheal catheter was inserted under a visual laryngoscope and mechanical ventilation was performed.The degree of opening,intubation time,success rate of intubation,intubation injury,complications in postural position and surgical time,as well as the mean arterial pressure(MAP),heart rate(HR)and end tidal carbon dioxide partial pressure(PETCO2)before induction,during tracheal intubation,during postural position,during and after surgery were recorded.Pulmonary complications such as atelectasis and pneumothorax were analyzed by digital X-ray.Results There were no differences in terms of mouth opening,intubation time,intubation success rate,intubation injury,surgical time,pulmonary complications,and MAP,HP,and PETCO2 before induction,during tracheal intubation,during surgery,and after surgery between the observation group and the control group(P＞0.05).The observation group had smaller fluctuations in MAP and lower incidence of complications in postural position(P＜0.05).Conclusion Tracheal intubation in prone position is feasible for elderly patients with ERCP,with fewer complications.The positive end expiratory pressure ventilation mode has a certain lung protective effect on elderly patients.
基金项目
河南省医学科技攻关计划项目(LHGJ20220069)
河南省医学教育研究项目(Wjlx2021243)
维普
万方数据