Bund M, Walz R, Logemann F, Seitz W, Kirchner E
Zentrum Anästhesiologie, Abt. I der Medizinischen Hochschule Hannover.
Anasthesiol Intensivmed Notfallmed Schmerzther. 1996 Sep;31(7):420-4. doi: 10.1055/s-2007-995951.
The present prospective study was designed to investigate the respiratory function during ventilation via a tube inserted through the nose into the pharynx. Results were compared with respiratory parameters measured during conventional mask ventilation in the same patients.
20 ASA physical status I-II patients were studied after approval by the local Ethics Committee. Anaesthesia was induced with alfentanil 15 micrograms/kg and propofol 2.5-3.0 mg/kg and maintained with propofol, 12-15 mg/kg/h. Patients were ventilated via a facemask with oxygen and a tidal volume of approximately 8ml/kg (measurement A). After insertion of a tube (I.D. 7.0-7.5 mm) through the nostril into the pharynx ventilation was repeated in the same manner (measurement B). To secure airway seal a second person closed the patient's mouth and exerted cricoid pressure. Following neuromuscular blockade with suxamethonium (1.5 mg/kg) respiratory parameters were measured again (C). Measurements included pulse oximetry and side stream spirometry with continuous collection of the following data: airway pressure, inspired and expired tidal volume, dynamic compliance, expired volume in one second, inspiratory and expiratory oxygen and carbon dioxide concentration. Pressure-volume and flow-volume loops were displayed continuously.
Ventilation via facial mask or via pharyngeal tube with and without relaxation showed normal endtidal FECO2. The mean values were 4.5 +/- 0.7%, 4.8 +/- 0.4% and 4.6 +/- 0.7%, respectively. Mean oxygen saturation exceeded 98% in each period. Leakage during mask ventilation was 59.3 +/- 65.5 mL and decreased to 40.5 +/- 62.1 mL with the pharyngeal tube, whereas relaxation resulted in a significant increase to 92.3 75.0 mL. Compliance (Cdyn) and expired volume in one second (V 1.0) did not change significantly during the entire period of measurement.
The use of a pharyngeally placed tube proved adequate compared to conventional mask ventilation in 20 patients without underlying airway disease.
本前瞻性研究旨在调查经鼻腔插入咽内的导管通气时的呼吸功能。将结果与同一患者在传统面罩通气时测量的呼吸参数进行比较。
经当地伦理委员会批准，对20例美国麻醉医师协会（ASA）身体状况为I-II级的患者进行研究。用阿芬太尼15微克/千克和丙泊酚2.5-3.0毫克/千克诱导麻醉，并用丙泊酚12-15毫克/千克/小时维持麻醉。患者通过面罩吸入氧气进行通气，潮气量约为8毫升/千克（测量A）。经鼻孔插入一根导管（内径7.0-7.5毫米）至咽内后，以相同方式重复通气（测量B）。为确保气道密封，由另一人闭合患者口腔并施加环状软骨压迫。用琥珀酰胆碱（1.5毫克/千克）进行神经肌肉阻滞之后，再次测量呼吸参数（C）。测量包括脉搏血氧饱和度测定和旁流肺量测定，并持续收集以下数据：气道压力、吸入和呼出潮气量、动态顺应性、一秒钟呼出量、吸入和呼出氧气及二氧化碳浓度。压力-容量环和流速-容量环持续显示。
在有或无肌肉松弛情况下，通过面罩或咽内导管通气时，呼气末二氧化碳分压（FECO2）均正常。平均值分别为4.5±0.7%、4.8±0.4%和4.6±0.7%。各阶段平均氧饱和度均超过98%。面罩通气时的漏气量为59.3±65.5毫升，使用咽内导管时降至40.5±62.1毫升，而肌肉松弛时则显著增加至92.3±75.0毫升。在整个测量期间，顺应性（Cdyn）和一秒钟呼出量（V 1.0）无显著变化。
对于20例无潜在气道疾病的患者，与传统面罩通气相比，使用置于咽内的导管通气效果良好。
