高流量鼻导管氧疗与喷射通气技术效果的比较
Comparison of the Effects of High-Flow Nasal Cannula Oxygen and Jet Ventilation Techniques.
文献信息
| PMID | 42838698 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Seda Özdağlı |
| 作者单位 | Istanbul Faculty of Medicine, Department of Anesthesiology, Istanbul University, Istanbul, Turkey. |
| 期刊 | The Laryngoscope |
| SCI 分区 | Q2 |
| IF | 2.3 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
目的：
喉内手术中的共享气道管理使手术操作与充分通气之间存在冲突。本研究比较了高频喷射通气（HFJV）与经鼻湿化快速充气通气交换（THRIVE，通过高流量鼻导管HFNC实施）对围手术期氧合、动脉血CO2动力学及代谢稳定性的影响。
方法：
在这项前瞻性随机对照研究中，36例接受择期喉内手术的患者（ASA I-II级）被随机分为HFJV组（n=18）或HFNC组（n=18）。两组均接受标准化的全凭静脉麻醉（TIVA）和神经肌肉阻滞。主要结局为五个时间点的纵向PaCO2变化：基线（T0）、诱导后10分钟（T1）、20分钟（T2）、30分钟（T3）以及手术结束时（T4）。次要结局包括PaO2、pH和乳酸。
结果：
T0和T1时PaCO2水平相当。在20分钟时（T2），HFNC组的PaCO2显著更高（55.5 vs. 44.5 mmHg；p=0.002）。在手术结束时（T4），HFNC组的中位PaCO2达到66.5 mmHg，而HFJV组为44.5 mmHg（p<0.001）。因此，HFNC组在T4时表现出显著更低的pH（7.21 vs. 7.31；p<0.001）和更高的乳酸（3.4 vs. 2.5 mmol/L；p<0.001）。HFJV组在T3和T4时的PaO2水平显著更优（p<0.001）。
结论：
虽然HFNC为短时手术提供了理想的无管术野，但其使用受到时间依赖性高碳酸血症和进行性呼吸性酸中毒的限制。我们提出HFNC的临床“20分钟阈值”；对于较长时间的喉内手术，首选HFJV以维持通气和代谢稳态。
试验注册：
本临床试验已在ClinicalTrials.gov注册（注册号NCT05746949）。
英文摘要
OBJECTIVES: Shared airway management in endolaryngeal surgery conflicts surgical access with adequate ventilation. This study compared the effects of High-Frequency Jet Ventilation (HFJV) and Transnasal Humidified Rapid-Insufflation Ventilatory Exchange (THRIVE) via High-Flow Nasal Cannula (HFNC) on perioperative oxygenation, arterial CO2 kinetics, and metabolic stability.
METHODS: In this prospective randomized controlled study, 36 patients (ASA I-II) undergoing elective endolaryngeal procedures were randomized into HFJV (n = 18) or HFNC (n = 18) groups. Both cohorts received standardized TIVA and neuromuscular blockade. Primary outcomes were longitudinal PaCO2 changes at five intervals: baseline (T0), 10 (T1), 20 (T2), 30 (T3) minutes post-induction, and at surgical conclusion (T4). Secondary outcomes included PaO2, pH, and lactate.
RESULTS: PaCO2 levels were comparable at T0 and T1. At 20 min (T2), PaCO2 was significantly higher in the HFNC group (55.5 vs. 44.5 mmHg; p = 0.002). At surgical conclusion (T4), median PaCO2 reached 66.5 mmHg in the HFNC group versus 44.5 mmHg in the HFJV group (p < 0.001). Consequently, the HFNC group exhibited significantly lower pH (7.21 vs. 7.31; p < 0.001) and elevated lactate (3.4 vs. 2.5 mmol/L; p < 0.001) at T4. PaO2 levels at T3 and T4 were significantly superior in the HFJV group (p < 0.001).
CONCLUSION: While HFNC offers an ideal tubeless field for short interventions, its use is limited by time-dependent hypercapnia and progressive respiratory acidosis. We propose a clinical "20-min threshold" for HFNC; for longer endolaryngeal procedures, HFJV is preferred to maintain ventilatory and metabolic homeostasis.
TRIAL REGISTRATION: This clinical trial was registered at ClinicalTrials.gov (registration number NCT05746949).