Natalini G, Cavaliere S, Vitacca M, Amicucci G, Ambrosino N, Candiani A
Department of Anaesthesia and Intensive Care, University of Brescia, Italy.
Acta Anaesthesiol Scand. 1998 Oct;42(9):1063-9. doi: 10.1111/j.1399-6576.1998.tb05377.x.
Ventilation during interventional rigid bronchoscopy (IRB) under general anaesthesia (jet ventilation, positive pressure ventilation and spontaneous assisted ventilation) may offer some difficulties. This study compares the effectiveness during IRB of intermittent negative pressure ventilation (INPV) and spontaneous assisted ventilation (SAV).
Thirty-eight patients submitted to IRB were randomised into two groups: SAV or INPV. All patients received a total intravenous anaesthesia; INPV patients were paralysed. Pre- and intra-operative arterial blood gases and O2 flow through a rigid bronchoscope were assessed. The endoscopist applying a subjective score evaluated the operating conditions.
Patients of the INPV group, as compared to the SAV group, required a lower dosage of fentanyl (2.6 +/- 1.8 micrograms.kg-1.h-1 vs. 6.6 +/- 4.8 micrograms.kg-1.h-1), a lower O2 supply (3.3 +/- 2.8 l/min vs. 11.6 +/- 3.4 l/min), a shorter recovery time (5.4 +/- 2.9 min vs. 9.8 +/- 7.1 min) and no manually assisted ventilation (0 +/- 0 vs. 1 +/- 1.1 n degree/procedure). Intraoperative PaCO2 was higher in the SAV (8.1 +/- 1.3 kPa) than in the INPV group (5.0 +/- 1.6 kPa) and intraoperative pH differed in the two groups (7.26 +/- 0.05, SAV vs. 7.47 +/- 0.08, INPV). Operating conditions, as assessed by a subjective score, were considered better with INPV than with SAV (4.9 vs. 4.3).
As compared to SAV, INPV in paralysed patients during IRB reduces administration of opioids, shortens recovery time, prevents respiratory acidosis, excludes the need for manually assisted ventilation, reduces O2 need and affords optimal surgical conditions. INPV appears a safe, non-invasive and effective ventilatory management during IRB.
全身麻醉下进行介入性硬质支气管镜检查（IRB）时的通气（喷射通气、正压通气和自主辅助通气）可能会遇到一些困难。本研究比较了间歇性负压通气（INPV）和自主辅助通气（SAV）在IRB期间的有效性。
38例行IRB的患者被随机分为两组：SAV组或INPV组。所有患者均接受全静脉麻醉；INPV组患者使用了肌松剂。评估术前和术中的动脉血气以及通过硬质支气管镜的氧气流量。内镜医师采用主观评分法评估操作条件。
与SAV组相比，INPV组患者所需芬太尼剂量更低（2.6±1.8微克·千克⁻¹·小时⁻¹对6.6±4.8微克·千克⁻¹·小时⁻¹），氧气供应量更低（3.3±2.8升/分钟对11.6±3.4升/分钟），恢复时间更短（5.4±2.9分钟对9.8±7.1分钟）且无需人工辅助通气（0±0对1±1.1次/操作）。SAV组术中动脉血二氧化碳分压（PaCO₂）（8.1±1.3千帕）高于INPV组（5.0±1.6千帕），两组术中pH值也不同（SAV组为7.26±0.05，INPV组为7.47±0.08）。根据主观评分评估，INPV组的操作条件优于SAV组（4.9对4.3）。
与SAV相比，IRB期间对使用肌松剂的患者采用INPV可减少阿片类药物的使用，缩短恢复时间，预防呼吸性酸中毒，无需人工辅助通气，减少氧气需求并提供最佳手术条件。INPV似乎是IRB期间一种安全、无创且有效的通气管理方法。
