在预计有呼吸道困难的患者中,在麻醉诱导期间,压力控制和手动通风之间的比较:一项前性随机对照试验
Jeong Jun Park1, Hyunyoung Seong2, Hyub Huh3
1Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea.
Medicine
|September 1, 2023
概括
与手动通风相比,压力控制通风可显著降低面罩通风期间的胃灌气和呼吸道峰值压力,与手动通风相比,患者有困难的呼吸道.
科学领域:
- 麻醉学 麻醉学
- 航空航道管理的管理.
- 关键护理医学 关键护理医学
背景情况:
- 胃 insufflation 和 regurgitation 是麻醉期间的风险,特别是在预期呼吸道困难的患者.
- 有效的通风策略至关重要,以尽量减少麻醉诱导期间的这些风险.
研究的目的:
- 为了比较手动通风和压力控制通风之间的呼吸系统参数和胃灌气率.
- 评估通风模式对预计难以进行面罩通风的患者的影响.
主要方法:
- 预测有呼吸道困难的80名患者被随机分为人工通风 (n=40) 或压力控制通风 (n=40) 组.
- 使用面罩进行通风,并根据潮体积 (6-8毫升/公斤) 调整压力控制通风.
- 气道压力峰值,潮尾二氧化碳和胃 insufflation (通过超声波) 是主要和次要结果.
主要成果:
- 与手动通风相比,压力控制的通风导致气道峰值压力显著降低 (P=.005) 和高端潮二氧化碳 (P=.012).
- 手动通风组中42.5%的患者出现胃不通气,压力控制通风组中为7.5% (P=.003).
- 胃不通风的风险比率在压力控制通风时显著降低.
结论:
- 在面罩麻醉过程中,压力控制通风优于手动通风,可以减少呼吸道困难的患者在面罩麻醉期间的胃灌气.
- 这种方法还可以实现更低的高峰气道压力,提高患者的安全性.
- 超声波是一个有价值的工具,用于实时评估胃灌气.
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