目的: 探究双手托下颌法联合右肘部温和胸外按压对无痛纤维支气管镜检查中低氧血症的防治效果。方法: 筛选择期行无痛纤维支气管镜检查的患者120例,随机分为双手托下颌法组（B组）、双手托下颌法联合右肘部温和胸外按压组（BT组）,每组 60例,待患者意识消失后,B组给予双手托下颌法（下颌角前移0.5~1 cm）,BT组给予双手托下颌法和右肘部温和胸外按压（按压幅度2~3 cm,频率 30次/min）。比较两组寻找声门并通过声门的时间、血氧下降（SpO2<基础值）、低氧状态（SpO2<95%）以及低氧血症（SpO2<90%）的发生率;两组退纤支镜行面罩通气率和手术前后膈肌活动度（diaphragmatic excursion,DE）。结果: BT组血氧下降、低氧状态和低氧血症的发生率较B组均明显减少;BT组给药后2 min的膈肌活动度较B组明显增加。结论: 双手托下颌法联合右肘部温和胸外按压能降低无痛纤维支气管镜检查中低氧血症的发生,增强镇静状态下膈肌的运动,是一种简便、可单人操作且安全有效的方法,值得推广。
Abstract
Objective To explore the effect of Jaw-thrust maneuver combined with gentle chest compression with right elbow to prevent hypoxemia in painless fiberoptic bronchoscopy. Methods 120 patients who underwent painless fiberoptic bronchoscopy were randomly divided into two groups, 60 patients in each group: group B (Jaw-thrust maneuver with both hands) and group BT (Jaw-thrust maneuver with both hands combined with gentle chest compression on the right elbow). After the patient's consciousness disappeared, the group B was given Jaw-thrust maneuver with both hands (mandibular angle moved forward by 0.5-1cm), and the group BT was received Jaw-thrust maneuver and gentle chest compression with the right elbow (the compression range is 2-3cm, the frequency is 30 times per min, a total of 20 times). The total time of searching and passing glottis, the incidence of the decline of blood oxygen (SpO2<basic value), hypoxia state (SpO2<95%) and hypoxemia (SpO2<90%) in each group were compared. Besides, we collected the ventilation rate of face mask and diaphragm activity (DE) in each group. Results The incidence of the decline of blood oxygen, hypoxia state and hypoxemia in the group BT was significantly lower than that in B group. The diaphragmatic activity of 2 min after injection of the group BT was significantly increased compared with group B. Conclusion The method of Jaw-thrust maneuver combined with gentle chest compression with right elbow can reduce the occurrence of hypoxemia in painless fiberoptic bronchoscopy and enhance the movement of diaphragm under sedation. It is a simple, safe and effective method which is worth popularizing.
关键词
纤维支气管镜检查 /
低氧血症 /
托下颌法 /
胸外按压
Key words
fiberoptic bronchoscopy /
hypoxemia /
mandibular holding method /
chest compression
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基金
湖南省自然科学基金项目“颊针疗法联合SGB在老年患者腹腔镜结肠癌根治术POSR及睡眠质量的探究”（2024JJ9524）; 长沙市卫生健康委中医药科研计划项目“颊针疗法对老年患者腹腔镜结肠癌根治术POSR的探究”（B202302）
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