南方医科大学学报

南方医科大学学报 ›› 2023, Vol. 43 ›› Issue (9): 1599-1605.doi: 10.12122/j.issn.1673-4254.2023.09.18

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THRIVE联合i-gel喉罩在经输尿管软镜碎石术中延长无通气氧合时间

张 晨，廖宏森，李浩甲，徐亚杰，张 桂，王晓亮，鲍红光   

  1. 南京医科大学附属南京医院（南京市第一医院）麻醉科，江苏 南京 210006；南京医科大学附属脑科医院麻醉科，江苏 南京 210029
  • 出版日期:2023-09-20 发布日期:2023-09-28

THRIVE combined with i-gel laryngeal mask for prolonging apneic oxygenation time in retrograde intrarenal surgery

ZHANG Chen, LIAO Hongsen, LI Haojia, XU Yajie, ZHANG Gui, WANG Xiaoliang, BAO Hongguang   

  1. Department of Anesthesiology, Nanjing Hospital Affiliated to Nanjing Medical University/ Nanjing First Hospital, Nanjing 210006, China; Department of Anesthesiology, Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
  • Online:2023-09-20 Published:2023-09-28

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摘要： 目的 探究THRIVE联合i-gel喉罩对输尿管软镜碎石术的无通气状态下氧疗的安全性及手术精准性的影响。方法 纳入喉罩全身麻醉下行输尿管软镜碎石术的患者120例，随机分为3组：对照组（C组）、高频小潮气量组（H组）、THRIVE组（T组），每组40例。待输尿管软镜进入肾盂寻找到结石后，C组采用呼吸机APPV模式辅助通气，H组切换为小潮气量高呼吸频率模式，T组断开呼吸机，改用THRIVE联合喉罩供氧。记录3组碎石操作所用时间及手术者满意度、膈肌动度、输尿管黏膜损伤次数；记录3组患者入室、置入喉罩即刻、碎石开始、碎石开始10、20、30 min、出PACU各时刻的动脉血压、心率、SpO2、PaO2、PaCO2和pH值的变化情况。结果 相较于其他两组，T组外科医生碎石操作时间显著缩短，满意度显著提高，患者膈肌动度显著减少，术中黏膜损伤次数显著减少；3组患者之间动脉血压、心率、SpO2无显著差异；与碎石开始时相比，H组及T组碎石20 min及30 min时间点PaO2均下降，T组碎石10、20及30 min各时间点PaCO2均显著升高，T组碎石10、20及30 min各时间点pH均显著降低；3组患者出PACU时氧合指标无显著差异。结论 THRIVE联合i-gel喉罩用于输尿管软镜碎石术无通气期间氧疗可提高手术精准性，且在30 min内维持患者氧合指标于可控制范围内。

关键词: 快充式经鼻湿化高流量通气；输尿管软镜碎石术；无通气氧合；手术精准性

Abstract: Objective To explore the effect of THRIVE combined with i-gel laryngeal mask on the safety of oxygen therapy in apnea and surgical precision of retrograde intrarenal surgery. Methods A total of 120 patients undergoing retrograde intrarenal surgery under general anesthesia with laryngeal mask were randomized into 3 groups (n=40), and after the flexible ureteroscope entered the renal pelvis and located the stones, the patients received assisted ventilation in APPV mode (control group), ventilation with small tidal volume and high respiratory rate (group H), or THRIVE combined with laryngeal mask for oxygen supply without using the ventilator (THRIVE group). The time for lithotripsy by the surgeons, surgeons' satisfaction, diaphragm mobility, and times of urinary tract mucosal injury were recorded, and arterial blood pressure, heart rate, SpO2, PaO2, PaCO2, and pH value were measured before, during and after lithotripsy. Results Among the 3 groups, THRIVE group had the shortest time for lithotripsy, best satisfaction of the surgeons, the lowest diaphragmatic mobility of the patients, and the smallest number of mucosal injuries. The arterial blood pressure, heart rate, and SpO2 of the patients did not differ significantly among the 3 groups. At 20 min and 30 min after the start of lithotripsy, PaO2 decreased significantly in group H and THRIVE group; in THRIVE group, PaCO2 increased and pH decreased significantly at 10, 20 and 30 min after the start of lithotripsy. No significant difference was found in oxygenation indicators among the 3 groups upon discharge from the PACU. Conclusion In retrograde intrarenal surgery, THRIVE combined with i- gel laryngeal mask for oxygen therapy during the anaerobic period can improve the surgical accuracy and maintain the patient's oxygenation index in a controllable range within 30 min.

Key words: transnasal humidified rapid-insufflation ventilatory exchange; retrograde intrarenal surgery; apneic oxygenation; surgical precision