声门上与声门下喷射通气在支气管超声引导下经支气管针吸活检术中的应用:一项随机对照试验

2021
02/23

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声门上与声门下喷射通气在支气管超声引导下经支气管针吸活检术中的应用:一项随机对照试验

 
背景

对于全麻、支气管超声引导下支气管针吸活检术(EBUS-TBNA),既可以使用硬质支气管镜,也可以使用附加高频喷射通气功能的喉罩(LMA)。尽管在欧洲用于EBUS-TBNA的硬性支气管镜检查仍被广泛使用,但越来越多的医院通过LMA使用喷射通气进行这一手术。目前,还没有通过临床试验对这两种方法进行比较。这项试验的目的是评估与需要肌肉松弛剂和深度麻醉的硬性支气管镜检查相比,使用LMA通气时患者是否更快地从手术中恢复。

 
目的

我们假设使用硬性支气管镜和LMA喷射通气对EBUS-TBNA术后麻醉监护病房(PACU)的患者的术后恢复没有影响,并对其进行检验。次要观察指标是两组麻醉时间、手术诊断结果和用药量的差异。

 
设计

前瞻性随机、单盲、双中心对照试验。

 
范围设置

纳入2016年12月到2018年1月奥地利两个研究中心的患者。

 
对象

90名接受择期EBUS-TBNA的患者随机分配到两个干预组。最终对77人进行了分析(术前排除2例,术后排除11例)。

 
干预措施

分组1的患者接受LMA通气;分组2的患者通过硬性支气管镜通气。记录生命体征、用药量、麻醉时间、苏醒时间、PACU停留时间和Aldrete评分。

 
主要结果

主要结果指标是改良的Aldrete评分随时间的积分。次要指标为干预时间、麻醉苏醒时间、PACU停留时间、PACU初始Aldrete值和平均值、Schnider药代动力学模型下异丙酚的作用部位浓度、最终峰值率和诊断结果。

 
结果

根据Aldrete评分、测量的持续时间和诊断结果,我们在术后恢复标准方面没有发现任何显著差异。两组生命体征保持稳定,范围相同。异丙酚的平均作用部位浓度和峰值终末速率没有差异。

 
结论

全麻下行EBUS-TBNA手术时,使用LMA加SHJV与硬性支气管镜的恢复效果相当。

 

 

 
英文原文

 

 
ABSTRACT


Infraglottic versus supraglottic jet-ventilation for endobronchial ultrasound-guided transbronchial needle aspiration:A randomised controlled trial



BACKGROUND For endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) under general anaesthesia, both rigid bronchoscopy and laryngeal masks (LMAs) with superimposed high-frequency jet ventilation can be used. Despite the fact that in Europe rigid bronchoscopy for EBUS-TBNA is still widely used, an increasing number of centres use jet ventilation via the LMA for this procedure. To our knowledge no clinical trials have ever been made to compare these two methods. This trial aimed to evaluate whether patients recover from the procedure more quickly when a LMA is used for ventilation compared with rigid bronchoscopy where muscle relaxants and deep anaesthesia are required.

OBJECTIVES We wanted to test the hypothesis that there is no difference in the postoperative recovery of patients in the postanaesthesia care unit (PACU) after EBUS-TBNA with jet ventilation via a rigid bronchoscope and a LMA. Secondary outcomes were the difference of duration of anaesthesia, the diagnostic outcome of the procedure and drug quantities for both groups.

DESIGN Prospective randomised single blinded two centre controlled trial.

SETTING Two centres in Austria participated. Patients were enrolled from December 2016 until January 2018.

PATIENTS Ninety patients for elective EBUS-TBNA were enrolled and assigned to one of two intervention groups. Two patients were excluded before and eleven patients were excluded after EBUS-TBNA. Seventy-seven were analysed.

INTERVENTIONS Patients assigned to group 1 were ventilated with a LMA; those assigned to group 2 were ventilated via a rigid bronchoscope. Vital signs, drug dosage, duration of anaesthesia, recovery, PACU stay and Aldrete score at the PACU were recorded.

MAIN OUTCOME MEASURES The primary endpoint was an integral over time of a modified Aldrete score. Secondary endpoints were the durations of the interventions, the recovery from anaesthesia and PACU stay, initial and mean Aldrete values at PACU, the effect site concentration of Propofol according to the Schnider pharmacokinetic model, the peak ultiva rates and the diagnostic outcome.

RESULTS We were not able to show any significant difference regarding the postoperative recovery criteria based on the Aldrete score, the durations measured and the diagnostic outcomes. Vital signs remained stable and in an equal range in both groups. There were no differences in the mean effect site propofol concentration and the peak ultiva rates.

翻译:牛振瑛    编辑:佟睿    审校:曹莹

贵州医科大学 高鸿教授课题组


 


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本微信公众平台所刊载原创或转载内容不代表米勒之声的观点或立场。文中所涉及药物使用、疾病诊疗等内容仅供参考。


本文由作者自行上传,并且作者对本文图文涉及知识产权负全部责任。如有侵权请及时联系(邮箱:nanxingjun@hmkx.cn
关键词:
支气管镜,活检术,试验,超声,麻醉,手术

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