Bacher A, Lang T, Weber J, Aloy A
Department of Anesthesiology and General Intensive Care, University of Vienna, Austria.
Anesth Analg. 2000 Dec;91(6):1506-12. doi: 10.1097/00000539-200012000-00039.
We tested the respiratory efficacy of different jet ventilation techniques (subglottic low-frequency versus subglottic combined-frequency and subglottic combined-frequency versus supraglottic combined frequency) in patients undergoing microlaryngeal surgery. The PaCO(2) and the quotient of arterial oxygen tension (PaO(2)) over FIO(2) were measured. After anesthetic induction (propofol, remifentanil, vecuronium), an endotracheal Mon-Jet catheter (Xomed, Jacksonville, FL) for subglottic jet ventilation and a laryngoscope for supraglottic jet ventilation (Carl Reiner G.m.b.H., Vienna, Austria) were inserted. In Group 1 (n = 18), subglottic low-frequency (15 breaths/min), combined-frequency (600 and 15 breaths/min), and low-frequency jet ventilation was subsequently performed (15 min each). In Group 2 (n = 19), the sequence was supraglottic, subglottic, and supraglottic combined-frequency jet ventilation. The driving pressures were initially adjusted to achieve normocapnia and were not changed during the entire study period. The FIO(2) was measured endotracheally. The Wilcoxon's signed rank test was applied. In Group 1, PaCO(2) and PaO(2)/FIO(2) improved significantly after switching from subglottic low-frequency to subglottic combined-frequency jet ventilation (PaCO(2), from 46.6 +/-8.3 to 42.1+/-8.1 mm Hg; PaO(2)/FIO(2), from 311+/-144 to 361+/-141 mm Hg; P<0.05). In Group 2, PaCO(2) increased and PaO(2)/FIO(2) decreased significantly after switching from supraglottic to subglottic combined-frequency jet ventilation (PaCO(2), from 39.4+/-7.1 to 45.9+/-7.5 mm Hg; PaO(2)/FIO(2), from 415+/-114 to 351+/-129 mm Hg; P<0.05). We conclude that subglottic combined-frequency jet ventilation is less effective than supraglottic combined-frequency ventilation, but more effective than subglottic low-frequency jet ventilation.
The combination of high and low respiratory frequencies (600 and 15 breaths/min) improves pulmonary gas exchange during subglottic jet ventilation via an endotracheal catheter. However, subglottic combined-frequency jet ventilation is less effective than supraglottic combined-frequency jet ventilation via a jet ventilation laryngoscope.
我们在接受微喉手术的患者中测试了不同喷射通气技术（声门下低频通气与声门下联合频率通气以及声门下联合频率通气与声门上联合频率通气）的呼吸效果。测量了动脉血二氧化碳分压（PaCO₂）以及动脉血氧分压（PaO₂）与吸入氧分数（FIO₂）的比值。麻醉诱导（丙泊酚、瑞芬太尼、维库溴铵）后，插入用于声门下喷射通气的气管内Mon-Jet导管（Xomed，佛罗里达州杰克逊维尔）和声门上喷射通气的喉镜（卡尔·赖纳有限公司，奥地利维也纳）。在第1组（n = 18）中，随后依次进行声门下低频（15次/分钟）、联合频率（600次/分钟和15次/分钟）以及低频喷射通气（各15分钟）。在第2组（n = 19）中，顺序为声门上、声门下和声门上联合频率喷射通气。初始驱动压力调整至实现正常碳酸血症，且在整个研究期间保持不变。经气管测量FIO₂。应用威尔科克森符号秩检验。在第1组中，从声门下低频喷射通气转换为声门下联合频率喷射通气后，PaCO₂和PaO₂/FIO₂显著改善（PaCO₂从46.6±8.3降至42.1±8.1 mmHg；PaO₂/FIO₂从311±144升至361±141 mmHg；P<0.05）。在第2组中，从声门上联合频率喷射通气转换为声门下联合频率喷射通气后，PaCO₂升高且PaO₂/FIO₂显著降低（PaCO₂从39.4±7.1升至45.9±7.5 mmHg；PaO₂/FIO₂从415±114降至351±129 mmHg；P<0.05）。我们得出结论，声门下联合频率喷射通气不如声门上联合频率通气有效，但比声门下低频喷射通气更有效。
高呼吸频率和低呼吸频率（600次/分钟和15次/分钟）的组合通过气管内导管在声门下喷射通气期间改善肺气体交换。然而，声门下联合频率喷射通气不如通过喷射通气喉镜进行的声门上联合频率喷射通气有效。
