肩高头后仰位对非插管全身麻醉纤维支气管镜检查术中气道梗阻和低氧的影响

Effect of shoulder-high head back-up position on airway obstruction and hypoxia during fiberoptic bronchoscopy under non-intubated general anesthesia

中文关键词: 体位  非插管全身麻醉  纤维支气管镜检查术  气道梗阻  低氧

英文关键词: Position  Non-intubated general anesthesia  Fiberoptic bronchoscopy  Airway obstruction  Hypoxia

中文摘要:

      
目的：观察肩高头后仰位对非插管全身麻醉纤维支气管镜（FOB）检查术中气道梗阻和低氧的影响。
方法：选择拟行无痛FOB检查的患者170例，男97例，女73例，年龄18～64岁，BMI 18.5～28.0 kg/m²，ASA Ⅰ—Ⅲ级。采用随机数字法将患者分为两组：观察组（D组，n=84）和对照组（C组,n=83）。D组采用肩高头后仰位，C组采用平卧位。两组均采用丙泊酚复合舒芬太尼静脉全身麻醉，普通内镜面罩吸氧8～10 L/min，当改良警觉/镇静（MOAA/S）评分≤1分时开始实施FOB检查。记录术中低氧及采取矫正措施例数，麻醉诱导前（T1）、麻醉诱导后1 min（T2）、气管内表面麻醉（T3）、FOB检查时（T4）及检查结束时（T5）的HR、SBP、DBP、SpO₂。记录T2时腭后间隙和舌后间隙梗阻程度，术中声门显露情况和内镜医师操作舒适度。记录术后颈部不适、头痛、头晕和恶心呕吐等不良事件的发生情况。
结果：与C组比较，D组术中中度低氧、重度低氧、托下颌和辅助通气发生率明显降低（P<0.05）。与T1时比较，两组T3、T4时HR明显增快（P<0.05），T2、T4、T5时SBP和DBP明显降低（P<0.05），T2时SpO₂明显升高（P<0.05），T4时SpO₂明显降低（P<0.05）；C组T3时SpO₂明显降低（P<0.05）。与C组比较，D组T4时SpO₂明显升高（P<0.05），T2时舌后间隙无梗阻发生率明显升高，完全梗阻发生率明显降低（P<0.05）。与C组比较，D组声门显露差发生率明显降低，内镜医师操作舒适度明显升高（P<0.05）。两组术后不良事件发生率差异无统计学意义。
结论：肩高头后仰位可减轻非插管全身麻醉FOB检查术中的气道梗阻，降低术中低氧的发生率。

英文摘要:

      
Objective: To observe the effect of shoulder-high head back-up position on airway obstruction and hypoxia during fiberoptic bronchoscopy under non-intubated general anesthesia.
Methods: A total of 170 patients undergoing painless fiberoptic bronchoscopy, 97 males and 73 females, aged 18-64 years, BMI 18.5-28.0 kg/m², ASA physical status Ⅰ-Ⅲ, were randomly divided into two groups by random number method: observation group (group D, n = 84) and control group (group C, n = 83). Group D adopted the shoulder-high head back-up position, and group C adopted the supine position. All the patients received intravenous general anesthesia of propfol combined with sufentanil, and were oxygenated via an ordinary endoscopic mask with an oxygen flow rate of 8-10 L/min. Fiberoptic bronchoscopy was performed when the modified observer assessment of alertness and sedation (MOAA/S) score was ≤ 1 point. The number of cases in which hypoxia occurred and corrective measures were taken were recorded. The changes of HR, SBP, DBP, and SpO₂ before induction of anesthesia (T1), 1 minute after induction of anesthesia (T2), endotracheal surface anesthesia (T3), at the time of examination (T4), and at the end of the examination (T5) were recorded. The degree of obstruction of the retropalatal space and retroglossal space at T2 were recorded. The level of glottic exposure and operating comfort of the endoscopist were recorded during the examination, and the incidence of postoperative neck discomfort, postoperative headache, postoperative dizziness, and nausea and vomiting were recorded.
Results: Compared with group C, the incidence of intraoperative moderate hypoxia, severe hypoxia, jaw support, and assisted ventilation was significantly decreased in group D (P < 0.05). Compared with T1, the HR were significantly increased at T3 and T4(P < 0.05), SBP and DBP were significantly decreased at T2, T4, and T5 (P < 0.05), SpO₂ was significantly increased at T2 and decreased at T4 in the two groups (P < 0.05), and SpO₂ in group C was significantly decreased at T3 (P < 0.05). Compared with group C, SpO₂ was significantly increased at T4, the incidence of non-obstruction in the retrolingual space was significantly increased, and the incidence of complete obstruction in the retrolingual space was significantly decreased at T2, and the incidence of good glottic exposure was significantly increased, the incidence of poor glottic exposure was significantly decreased, and the incidence of good operating comfort of the endoscopist was significantly increased in group D (P < 0.05). There was no significant difference in the incidence of postoperative adverse events between the two groups.
Conclusion: Shoulder-high head back-up position can alleviate airway obstruction and reduce the incidence of hypoxia during fiberoptic bronchoscopy under non-intubated general anesthesia．