Kjaergaard Benedict, Zepernick Peter R, Bergmann Annette, Jensen Henrik K, Mladenovic Milka, Rasmussen Bodil S
Department of Cardiothoracic Surgery, Centre for Cardiovascular Research, and Biomedical Research Laboratory, Aalborg University Hospital, Aalborg, Denmark.
Multidiscip Respir Med. 2013 Dec 6;8(1):73. doi: 10.1186/2049-6958-8-73.
It can be difficult to perform CT guided biopsy of small pulmonary nodules especially if the position is behind a costa or close to the diaphragm and respiratory movements may hamper the procedure. During apneic oxygenation with a pulmonary standstill these movements can be hindered.
Six patients with decreased lung function and suspicious lung nodules are presented. Under general anesthesia including a muscle relaxant and a cuffed tube in the trachea CT guided biopsy was prepared. Just before the biopsy the ventilation mode was switched to a continuous positive airway pressure of 5-10 cm H2O, maintaining 100% oxygen delivery without ventilation. If the position of the lung nodule was inconvenient for biopsy the pressure was increased to up to 17 cm H2O to expand the lungs to a better biopsy position. After retrieving the biopsy controlled ventilation was re-established and a finishing control CT-scan was performed. Blood gas analyses were performed with few minutes interval.
All biopsies were diagnostic. All patients survived the procedure with no major complications, but 3 patients developed pneumothorax. The length of apneic oxygenation was median 10 minutes (8-10 minutes). No major changes in vital parameters were observed, and in all patients the peripheral oxygen saturation was 100% throughout the procedure. The arterial oxygen tension rose to very high values and the lowest pH was 7.18.
It is possible to perform lung biopsies in selected patients with decreased lung function during apneic oxygenation in at least 10 minutes in a safe way.
对小的肺结节进行CT引导下活检可能具有挑战性，尤其是当结节位于肋骨后方或靠近膈肌时，呼吸运动可能会妨碍该操作。在肺静止的情况下进行无呼吸氧合时，这些运动可得到抑制。
介绍了6例肺功能减退且有可疑肺结节的患者。在全身麻醉（包括使用肌肉松弛剂和气管内带套囊的气管导管）下准备进行CT引导下活检。就在活检前，通气模式切换为持续气道正压5 - 10厘米水柱，维持100%的氧气输送且不进行通气。如果肺结节的位置不利于活检，则将压力增加至高达17厘米水柱，以使肺扩张到更好的活检位置。获取活检样本后重新建立控制通气，并进行最终的对照CT扫描。每隔几分钟进行一次血气分析。
所有活检均具有诊断价值。所有患者均存活，无重大并发症，但有3例患者发生气胸。无呼吸氧合的时间中位数为10分钟（8 - 10分钟）。未观察到生命体征参数的重大变化，所有患者在整个过程中周围血氧饱和度均为100%。动脉血氧张力升至非常高的值，最低pH值为7.18。
对于选定的肺功能减退患者，在无呼吸氧合期间以安全的方式进行至少10分钟的肺活检是可行的。
