Aloy A, Kimla T, Schragl E, Donner A, Grasl M
Klinik für Anästhesie und Allgemeine Intensivmedizin, Universität Wien.
Laryngorhinootologie. 1994 Aug;73(8):405-11. doi: 10.1055/s-2007-997162.
Massive stenosis of the larynx may present a potentially life-threatening situation for the patient, requiring immediate measures to ensure a patient's airway. The aim of this prospective study was to evaluate potential benefits of Superimposed High Frequency Jet Ventilation (SHFJV) in patients requiring microlaryngeal surgery due to massive stenosis of the larynx.
23 patients (age range 1.5 to 90 years) with laryngeal stenosis grade 2 and 3 according to the Cotton scale were ventilated using SHFJV. The duration of the SHFJV was 12 to 116 minutes. SHFJV was performed using a Bronchotron Respirator via a jet-laryngoscope.
Arterial blood gases demonstrated paO2 between 71 and 295 mmHg and paCO2 of 28 to 81 mmHg. The mean FiO2 applied was 61.75 +/- 19.26. The airway pressure was measured at the tip of the jet-laryngoscope and was between 6 and 15 mmHg, and PEEP was 1 to 5 mmHg. In 13 patients a CO2 laser was utilised during surgery.
In all patients SHFJV was performed without problems. Since the ventilation is delivered above any possible stenosis the danger of barotrauma is minimised. The surgeon obtains optimal visibility of the larynx and is not obstructed in the surgical procedure. SHFJV enables both the surgeon and the anesthetist to perform their respective duties and therefore increases the safety of the patient in the management of such a difficult problem as massive stenosis of the larynx.
喉部严重狭窄可能给患者带来潜在的生命威胁，需要立即采取措施确保患者气道通畅。本前瞻性研究的目的是评估叠加高频喷射通气（SHFJV）对因喉部严重狭窄而需要进行显微喉镜手术的患者的潜在益处。
23例根据科顿量表评定为2级和3级喉部狭窄的患者（年龄范围1.5至90岁）采用SHFJV进行通气。SHFJV的持续时间为12至116分钟。通过喷射喉镜使用支气管呼吸机进行SHFJV。
动脉血气显示动脉血氧分压（PaO₂）在71至295 mmHg之间，动脉血二氧化碳分压（PaCO₂）在28至81 mmHg之间。平均应用的吸入氧浓度（FiO₂）为61.75±19.26。在喷射喉镜尖端测量气道压力，其范围在6至15 mmHg之间，呼气末正压（PEEP）为1至5 mmHg。13例患者在手术中使用了二氧化碳激光。
在所有患者中，SHFJV的实施均无问题。由于通气是在任何可能的狭窄部位上方进行的，气压伤的风险降至最低。外科医生能够获得喉部的最佳视野，并且在手术过程中不会受到阻碍。SHFJV使外科医生和麻醉师都能履行各自的职责，因此在处理喉部严重狭窄这一难题时提高了患者的安全性。
