Fritzsche K, Osmers A
Klinik für Anästhesiologie und Intensivtherapie, Medizinische Fakultät TU Dresden Fetscherstraße 74, 01309 Dresden.
HNO. 2011 Sep;59(9):931-41; quiz 942-3. doi: 10.1007/s00106-011-2369-x.
During surgical procedures of the upper respiratory tract anesthesiologists and surgeons are in a kind of competition situation because of the close spatial relationship between the airway of the patient and the surgical area. Especially in laryngeal surgery the use of high-frequency jet ventilation (HFJV) offers an alternative to the endotracheal tube. During HFJV the ventilation gas is intermittently administered by an injector with a high frequency into the airway which is open to the outside. Exhalation occurs passively in the area nearby the wall of the airway cross-section. According to the availability of the technique and the indications jet ventilation can be implemented in an infraglottic, supraglottic, transtracheal or transluminal manner. To exert influence on gas exchange of the patient the respiratory rate, driving pressure, oxygen concentration and inspiration time can be changed according to the needs. Severe tracheal stenosis, risk of excessive bleeding during the procedure, patients at risk for aspiration and exacerbation of lung diseases are depicted as contraindications for HFJV. Complications under HFJV are rare despite the limited conditions for monitoring gas exchange and mechanics of ventilation in contrast to conventional ventilation. A particular challenge for the anesthesiologist is the use of HFJV during laryngeal laser surgery.
在上呼吸道手术过程中，由于患者气道与手术区域空间关系紧密，麻醉医生和外科医生处于一种竞争状态。特别是在喉部手术中，高频喷射通气（HFJV）为气管插管提供了一种替代方法。在HFJV过程中，通气气体由喷射器以高频间歇地注入到向外界开放的气道中。呼气在气道横截面壁附近的区域被动发生。根据该技术的可用性和适应症，喷射通气可以通过声门下、声门上、经气管或经腔的方式实施。为了影响患者的气体交换，可以根据需要改变呼吸频率、驱动压力、氧浓度和吸气时间。严重气管狭窄、手术过程中出血过多的风险、有误吸风险的患者以及肺部疾病加重被描述为HFJV的禁忌症。与传统通气相比，尽管监测气体交换和通气力学的条件有限，但HFJV下的并发症很少见。麻醉医生面临的一个特殊挑战是在喉部激光手术中使用HFJV。
