超声引导下经支气管针吸术中叠加高频喷射通气vs压力控制通气：一项随机对照试验

IF 0.7 Q3 ANESTHESIOLOGY

Trends in Anaesthesia and Critical Care Pub Date : 2025-06-13 DOI:10.1016/j.tacc.2025.101571

Manman Liu , Zhen Yang , Biling Wu , Jie Liu , Yimei Lin , Juanlan Liu , Wanxia Xiong , Chao Liang

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引用次数: 0

摘要

背景：超声引导下经支气管针抽吸（EBUS-TBNA）期间的通气管理具有挑战性，因为共用气道以及低氧血症和高碳酸血症的风险。本研究比较了全身麻醉下声门上气道（SGA）的叠加高频喷射通气（SHFJV）和压力控制通气（PCV）的安全性和有效性。方法接受EBUS-TBNA的患者随机分配接受SHFJV或PCV治疗。主要结果为围手术期氧合指数（OI）的变化。次要结局包括术中低氧血症和高碳酸血症、围术期二氧化碳变化压（PaCO2）、血流动力学稳定性、术中和术后不良事件（ae）、SGA通气质量。结果88例患者中女性占28.4%；中位年龄为62岁)。总体而言，44名参与者随机分配到SHFJV组，44名参与者随机分配到PCV组。事后分析显示，SHFJV组在手术结束时OI改善明显(平均差异（MD) = 78.52, 95%可信区间（CI）， 30.35 ~ 126.68, P = 0.039）， 19分钟后PaCO2显著降低（MD = - 8.23, 95% CI = - 12.68 ~ - 3.77, P = 0.001）。两组患者术中、术后不良事件相似，术中低氧血症和高碳酸血症无显著差异。SHFJV组SGA通气质量较差的病例数（4.5%）少于PCV组（20%），显示SGA通气质量较好（P = 0.024）。结论：与PCV相比，shfjv显著改善了成骨不全，同时在EBUS-TBNA期间保持了相当的安全性。这些发现强调了SHFJV是一种很有前景的通气策略，特别是对于在复杂气道干预期间需要改善氧合的患者。中国临床试验注册中心；注册号：ChiCTR2300071799；URL: https://www.chictr.org.cn/showproj.html?proj=197551。

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Superimposed high-frequency jet ventilation vs. pressure-controlled ventilation in endobronchial ultrasound-guided transbronchial needle aspiration: A randomised controlled trial

Background

Ventilation management during endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is challenging because of shared airway use and the risks of hypoxaemia and hypercapnia. This study compared the safety and efficacy of superimposed high-frequency jet ventilation (SHFJV) and pressure-controlled ventilation (PCV) using a supraglottic airway (SGA) under general anaesthesia.

Methods

Patients undergoing EBUS-TBNA were randomly assigned to receive either SHFJV or PCV. The primary outcomes was perioperative changes in oxygenation index (OI). Secondary outcomes included intraoperative hypoxaemia and hypercapnia, perioperative changes pressure of carbon dioxide (PaCO₂), haemodynamic stability, intraoperative and postoperative adverse events (AEs), and SGA ventilation quality.

Results

All 88 patients (28.4 % female; median age, 62 years) were analysed. Overall, 44 participants were randomised to SHFJV, and 44 participants were randomised to PCV. Post-hoc analysis showed that the SHFJV group had significantly greater improvement in OI at the end of surgery (mean difference (MD) = 78.52, 95 % confidence interval (CI), 30.35 to 126.68), P = 0.039) and a significant decrease in PaCO₂ after 19 min (MD = −8.23, 95 % CI = −12.68 to −3.77, P = 0.001). Intraoperative and postoperative adverse events were similar between the groups, and no significant differences were observed in intraoperative hypoxaemia or hypercapnia. The SHFJV group had fewer cases of poor SGA ventilation quality (4.5 %) than the PCV group (20 %), demonstrating superior SGA ventilation quality (P = 0.024).

Conclusions

SHFJV significantly improved OI compared with PCV while maintaining comparable safety profiles during EBUS-TBNA. These findings underscore the SHFJV as a promising ventilation strategy, particularly for patients requiring improved oxygenation during complex airway interventions.