高流量鼻氧联合喷射通气用于无气管插管显微喉镜下声带息肉手术：一项随机对照试验
High-flow nasal oxygen combined with jet ventilation for tubeless microlaryngoscopic vocal fold polyp surgery: A randomised controlled trial.
文献信息
| PMID | 42719510 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Wenting Li |
| 作者单位 | Department of Anaesthesiology, The Jinhua Affiliated Hospital of Wenzhou Medical University, Jinhua, Zhejiang, China. |
| 期刊 | Indian journal of anaesthesia |
| SCI 分区 | Q2 |
| IF | 2 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
背景与目的： 无气管插管显微喉镜手术可提供无遮挡的手术视野，但呼吸暂停期间二氧化碳蓄积仍是一个值得关注的问题。经鼻湿化快速充气通气交换（THRIVE）可维持氧合，但清除二氧化碳的能力有限。本研究比较了在无气管插管声带息肉手术中THRIVE联合喷射通气与单用THRIVE的效果。
方法： 在这项单盲随机对照试验中，100名接受显微喉镜下声带息肉手术的成人被分配至单用THRIVE组（T组）或THRIVE联合喷射通气组（M组）。主要终点为从呼吸暂停开始至手术结束时经皮二氧化碳分压的变化（ΔPtcCO2）。同时还评估了氧合、不良事件、转为气管插管以及恢复特征。
结果： 与T组相比，M组患者的ΔPtcCO2明显更小（-0.56 ± 2.74 vs 10.98 ± 5.41 ± 5.41 mmHg；P < 0.001），手术结束时PtcCO2也更低（36.42 ± 2.13 vs 47.02 ± 6.16 mmHg；P < 0.001）。T组轻度氧饱和度下降的发生率高于M组[7/50（14%）vs 0/50（0%）；P = 0.019]，而两组均无患者发生低氧血症或需要气管插管。
结论： 在THRIVE基础上加用喷射通气可减少无气管插管显微喉镜下声带息肉手术中的术中二氧化碳蓄积，且不增加围手术期不良事件。
英文摘要
BACKGROUND AND AIMS: Tubeless microlaryngoscopic surgery provides an unobstructed operative field, but carbon dioxide accumulation remains a concern during apnoea. Transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) maintains oxygenation but has limited capacity for carbon dioxide clearance. This study compared THRIVE combined with jet ventilation with THRIVE alone during tubeless vocal fold polyp surgery.
METHODS: In this single-blind randomised controlled trial, 100 adults undergoing microlaryngoscopic vocal fold polyp surgery were allocated to THRIVE alone (Group T) or THRIVE combined with jet ventilation (Group M). The primary endpoint was the change in transcutaneous carbon dioxide partial pressure (ΔPtcCO2) from the onset of apnoea to the end of surgery. Oxygenation, adverse events, conversion to tracheal intubation, and recovery characteristics were also assessed.
RESULTS: Compared with Group T, patients in Group M showed a markedly smaller ΔPtcCO2 (-0.56 ± 2.74 vs 10.98 ± 5.41 ± 5.41 mmHg; P < 0.001) and a lower end-of-surgery PtcCO2 (36.42 ± 2.13 vs 47.02 ± 6.16 mmHg; P < 0.001). Mild oxygen desaturation occurred more frequently in Group T than in Group M [7/50 (14%) vs 0/50 (0%); P = 0.019], whereas no patient in either group developed hypoxaemia or required tracheal intubation.
CONCLUSION: Adding jet ventilation to THRIVE reduced intraoperative carbon dioxide accumulation during tubeless microlaryngoscopic vocal fold polyp surgery without increasing perioperative adverse events.