全麻成年患者中经鼻路径和经口路径通气效果的对比

发布时间：2018-04-19 23:33

本文选题：心肺复苏 + 面罩通气　；参考：《浙江大学》2014年博士论文

【摘要】：目的：因为非专业人员实施成人心肺复苏(CPR)时口对口人工呼吸(MMB)的作用被质疑,并且非专业人员被建议放弃MMB而进行单纯胸外按压CPR。我们怀疑有其它的呼吸方式比MMB效果更好。我们假设成人CPR,口对鼻人工呼吸(MNB)比MMB能更好的维持气道开放和通气。我们以成人非肌松状态的全身麻醉模拟需要CPR患者的昏迷和无自主呼吸状态,分别比较经鼻面罩和经口面罩通气效果及直接MNB和MMB的通气效果来验证我们的假设。方法：一共48例成年患者加入本实验。实验分为两部分：第一部分有28例患者在头中立位随机进行经鼻面罩通气和经口面罩通气；第二部分另外20例患者在头中立位和后仰位随机进行直接的MNB和MMB。本实验采用自身交叉对照,分别比较面罩通气和人工呼吸的有效通气率和呼吸参数(潮气量、吸气峰压和二氧化碳呼出量等),评价经鼻路径和经口路径的通气效果。结果：所有数据用均数±标准差或中位数(25%-75%位数)表示。实验第一部分：经鼻面罩通气的有效通气率100%(100%-100%)明显高于经口面罩0%(0-100%)00.001)。经鼻面罩的吸气峰压(15.3±2.9cmH2O)低于经口面罩的吸气峰压(27.3±7.7cmH2O)(p0.001).经鼻面罩的通气效率(呼出二氧化碳量/吸气峰压)0.3ml/cm H2O(0.2-0.6ml/cm H2O)高于经口面罩0.0ml/cm H2O(0.0-0.3ml/cm H2O)(p=0.01).第二部分：结合头中立位和头后仰位的所有数据,MNB的有效通气率91.1%(42.4-100%)明显高于MMB的43.1%(42.5-100%)(p0.001), MNB吸入潮气量320ml(141-533.5ml)和呼出潮气量324.5ml (140.8-509ml)分别高于MMB的136ml (43.5-355.5ml)和130.5ml (44.0-372.8ml)(p＜0.001).头中立位时,MNB的有效通气率和潮气量都高于MMB。头后仰位时,两种呼吸方式MMB和MNB无明显差别。结论：在未使用肌松剂的全身麻醉成人患者中,经鼻路径(鼻面罩和MNB)比经口路径(口面罩和MMB)的有效通气率更高、通气效果更好。MNB是否能改善心肺复苏患者的生存率还有待进一步研究。
[Abstract]:Objective: The role of non-professionals in the implementation of adult cardiopulmonary resuscitation (CPR) was questioned, and non-professionals were advised to give up MMB and simply press it out of the chest. We suspect there are other breathing patterns that work better than MMB. We hypothesized that adult CPR, oral to nasal artificial respiration (MNB) could maintain airway opening and ventilation better than MMB. We tested our hypothesis by comparing the ventilation effect of nasal mask and oral mask and the ventilation effect of direct MNB and MMB in patients with CPR by simulating general anesthesia in adult non-muscular relaxation state. Methods: A total of 48 adult patients were enrolled in this study. The experiment was divided into two parts: in the first part, 28 patients were randomly ventilated by nasal mask and oral mask in the head neutral position, and in the second part, the other 20 patients were randomly given direct MNB and MMB in the head neutral position and backward position. The effective ventilation rate and respiratory parameters (tidal volume, inspiratory peak pressure and carbon dioxide exhalation volume) of mask ventilation and artificial respiration were compared to evaluate the ventilation effect of nasal and oral pathways. Results: All data are represented by mean 卤standard deviation or median of 25-75%). The first part of the experiment: the effective ventilation rate through nasal mask was 100%-100%) significantly higher than that of 0 0-100% through mouth mask. The inspiratory peak pressure of the nasal mask was 15.3 卤2.9 cmH2O, which was lower than that of the nasal mask (27.3 卤7.7 cmH2O). The ventilation efficiency (exhalation carbon dioxide / inspiratory peak pressure of 0.3 ml / cm H2O(0.2-0.6ml/cm H 2O) of nasal mask was higher than that of 0.0ml/cm H2O(0.0-0.3ml/cm H 2O via nasal mask. Part two: the effective ventilation rate of MNB was 91.1and 42.4-100 (combined with head neutral position and head backward position), which was significantly higher than that of MMB (43.1-100ml) and 42.5-100ml (P 0.001C). The volume of tidal volume of MNB was 320ml ~ 141-533.5ml (324.5ml 140.8-509ml) higher than that of MMB (43.5-355.5ml) and 130.5ml 44.0-372.8ml (p < 0.001), respectively. The effective ventilation rate and tidal volume of MNB in head neutral position were higher than those of MMB. There was no significant difference in MMB and MNB between the two breathing modes. Conclusion: In general anesthetized adults without muscle relaxants, transnasal pathways (nasal masks and MNBs) had higher effective ventilation rates than oral pathways (face masks and MMBs). Whether the ventilation effect is better. MNB can improve the survival rate of patients with cardiopulmonary resuscitation (CPR) remains to be further studied.
【学位授予单位】：浙江大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R614

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