Objective: To evaluate the feasibility and safety of supraglottic tracheal tube ventilation by comparing with modified laryngeal mask airway ventilation during painless fiberbronchoscopy. Methods: This was a prospective study. Twenty-eight patients undergoing painless fiberbronchoscopy in Hangzhou First People's Hospital were randomly divided into 2 groups(n=14): supraglottic tracheal tube ventilation(group A) and modified laryngeal mask airway(group B). MAP, HR, SpO(2), P(ET)CO(2) and BIS were recorded after entering the operating room(T(0)), after anesthesia induction(T(1)), immediately after inserting laryngeal mask airway or tracheal tube(T(2)), fiberbronchoscopy inserting(T(3)), at the end of the operation(T(4)), and at the recovery of patients' consciousness(T(5)). The arterial carbon dioxide partial pressure(PaCO(2)), the time spent in successful positioning of the tube, the endoscope indwelling duration, operative time, tube drawing time, patients' awakening time, satisfaction of operators, adverse events during anesthesia, the numbers of bucking or body moving were also recorded.The dose of propofol and remifentanil were also statisticed. Results: P(ET)CO(2) in group A at T(0), T(1), T(2), T(3), T(4), T(5) were (36.9±4.1), (36.3±4.7), (38.1±5.6), (40.4±4.0), (48.8±7.7), (45.3±7.6) mmHg, P(ET)CO(2) in group B were (38.6±4.4), (37.8±5.6), (37.8±5.4), (37.4±6.7), (43.3±12.2), (43.5±8.0) mmHg, at the end of operation, the P(ET)CO(2) at T(4) and T(5) were significantly higher than at T(0) in group A and group B (F=14.582, 12.651, all P<0.05). The PaCO(2) in group A was (62.0±4.7) mmHg , which was significantly higher than group B at the end of operation[(51.9±4.2) mmHg, t=2.432, P<0.05]. The time spent successfully positioning the insertion in group A and group B were (17.6±7.5), (29.8±13.6)s, the endoscope indwelling duration were(0.8±0.1), (1.4±0.3)min, and the operation time were(32.3±4.3), (46.8±4.8)min, there were significantly difference between group A and group B(t=2.670, 2.214, 2.166, all P<0.05). There were no significantly difference of the numbers of bucking or body moving , the satisfaction of operators and patients, and adverse events (all P>0.05). Conclusion: Supraglottic tracheal tube ventilation for painless fiberbronchoscopy is a safe and effective procedure.
目的： 通过与改良喉罩控制通气方式比较，评价经气管导管声门上通气方式在无痛纤维支气管镜诊疗中的安全性和可行性。 方法： 前瞻性研究，选取2017年4至9月杭州市第一人民医院行无痛纤维支气管镜诊疗的患者共28例，采用随机数字表法将入选患者随机分为2组(n＝14)。A组：经气管导管声门上通气，B组：改良喉罩控制通气。记录两组患者入室后(T(0))，麻醉诱导后(T(1))，置管即刻(T(2))，纤支气管镜通过声门时(T(3))，术毕即刻(T(4))以及患者苏醒时(T(5))的心电图(ECG)、血压(BP)、心率(HR)、血氧饱和度(SpO(2))、呼末二氧化碳分压(P(ET)CO(2))、脑电双频指数(BIS)；并于术毕采集桡动脉血测二氧化碳分压值；记录插管/喉罩时间、纤支镜成功置入时间、手术时间、拔管时间、苏醒时间；评估术者和患者满意度；记录术中体动呛咳例数及其他不良事件；统计术中丙泊酚与瑞芬太尼使用总量。 结果： A组T(0)、T(1)、T(2)、T(3)、T(4)、T(5)时间点P(ET)CO(2)分别为(36.9±4.1)、(36.3±4.7)、(38.1±5.6)、(40.4±4.0)、(48.8±7.7)、(45.3±7.6)mmHg，B组分别为(38.6±4.4)、(37.8±5.6)、(37.8±5.4)、(37.4±6.7)、(43.3±12.2)、(43.5±8.0) mmHg，A、B两组术毕时，T(4)、T(5)时点P(ET)CO(2)较T(0)时点均显著升高，差异均有统计学意义(F＝14.582、12.651，均P<0.05)。A、B两组术毕动脉二氧化碳分压值分别为(62.0±4.7)、(51.9±4.2) mmHg，差异有统计学意义(t＝2.432，P<0.05)。A、B两组患者插管时间分别为(17.6±7.5)、(29.8±13.6)s，纤支镜成功置入时间分别为(0.8±0.1)、(1.4±0.3)min，手术时间分别为(32.3±4.3)、(46.8±4.8)min，差异均有统计学意义(t＝2.670、2.214、2.166，均P<0.05)；两组术中体动呛咳例数、术者和患者满意度、不良事件发生率差异均无统计学意义(均P>0.05)。 结论： 经气管导管声门上通气方式应用于纤维支气管镜诊疗过程中是可行的。.
Keywords: Bronchoscopy; Catheterization, peripheral; Glottis; Modified laryngeal mask airway.