Konrad F, Mezödy M, Goertz A, Marx T, Georgieff M
Abteilung für Anästhesie und Intensivmedizin, Kreiskrankenhaus Sigmaringen.
Anaesthesist. 1996 Sep;45(9):802-6. doi: 10.1007/s001010050313.
The administration of dry anaesthetic gases for ventilation leads to morphological changes of the tracheobronchial epithelium that may cause postoperative pulmonary complications. Therefore, additional humidification with a heat and moisture exchanger (HME) is suggested for ventilation during anaesthesia, particularly when using semi-open breathing systems. Recommendations concerning the use of a HME in the semi-closed system are controversial. There are no data in the literature as to whether a HME improves mucociliary transport under these conditions. We therefore studied bronchial mucus transport velocity (BTV) with and without the use of a HME in the semi-closed circle system in humans.
The study was approved by the ethics committee of our hospital. In a prospective, randomised trial a total of 22 patients undergoing major abdominal surgery were investigated. In all patients anaesthesia was induced and maintained with midazolam, fentanyl, and vecuronium. After intubation, a HME (BACT/VIRAL HME, Pharma Systems AB, Sweden) was inserted between the endotracheal tube and ventilation tubing in 11 patients; the other 11 were ventilated without a HME and served as controls. Ventilation was assisted with a fresh flow of 3 in a semi-closed system (Dräger Sulla 808 V with an 8 ISO circle system and Ventilog 2 ventilator, Drägerwek AG, Germany) and a 2:1 mixture of nitrous oxide and oxygen. The fresh gas passed through the soda lime canister. At the end of the operation BTV was measured with a small volume of albumin microspheres labeled with technetium Tc99m, which was deposited on the dorsal surface at the lower ends of the right and left main bronchi via a catheter placed in the inner channel of a fibre-optic bronchoscope.
The two groups were comparable with regard to age, sex, preoperative lung function, duration of mechanical ventilation, and dose of anaesthetics. There were no statistically significant differences in the BTVs.
BTV does not improve with the use of a HME in the semi-closed circle system with a fresh gas flow of 31. With modern anaesthesia machines lower fresh gas flows should be administered, whereby the humidity and temperature of the inspired gases are further increased.
使用干燥麻醉气体进行通气会导致气管支气管上皮的形态学改变，这可能会引起术后肺部并发症。因此，建议在麻醉期间通气时使用热湿交换器（HME）进行额外加湿，尤其是在使用半开放式呼吸回路时。关于在半封闭式系统中使用HME的建议存在争议。文献中没有关于在这些条件下HME是否能改善黏液纤毛转运的数据。因此，我们研究了在人体半封闭式循环系统中使用和不使用HME时的支气管黏液转运速度（BTV）。
本研究经我院伦理委员会批准。在一项前瞻性随机试验中，共对22例接受腹部大手术的患者进行了研究。所有患者均使用咪达唑仑、芬太尼和维库溴铵诱导和维持麻醉。插管后，11例患者在气管导管和通气管道之间插入一个HME（BACT/VIRAL HME，瑞典法玛系统公司）；另外11例患者不使用HME进行通气，作为对照组。在半封闭式系统（德国德尔格公司的Dräger Sulla 808 V，配有8 ISO循环系统和Ventilog 2呼吸机）中，以3的新鲜气流辅助通气，并使用氧化亚氮和氧气的2:1混合气体。新鲜气体通过碱石灰罐。手术结束时，通过将少量用锝Tc99m标记的白蛋白微球沉积在左右主支气管下端的背侧表面来测量BTV，这些微球通过放置在纤维支气管镜内通道中的导管注入。
两组在年龄、性别、术前肺功能、机械通气时间和麻醉药物剂量方面具有可比性。BTVs无统计学显著差异。
在新鲜气流为3的半封闭式循环系统中使用HME并不能改善BTV。使用现代麻醉机时，应给予更低的新鲜气流，从而进一步提高吸入气体的湿度和温度。
