|
|
全凭静脉非气管插管全身麻醉在临床麻醉中的研究进展
|
Abstract:
全凭静脉非气管插管全身麻醉是一种不进行气管插管，用麻醉药物使患者的意识消失，但保留自主呼吸，患者对手术刺激应激的反应减弱或消失的一种麻醉方式。随着麻醉技术和手术风险管理水平的提高以及ERAS理念的推广，使得该麻醉方法应用在部分手术领域应用日益广泛。该麻醉方式既保留自主呼吸，与控制呼吸的气管插管全身麻醉相比，难度更高，对麻醉医生来说是一个巨大的挑战。但此方法使患者更舒适无记忆的同时，又能使创伤应激反应最小，恢复快。本文通过对近年来的相关研究进行收集分析，现将其综述如下。
General anesthesia with intravenous non-intubated anesthesia is a type of anesthesia in which the patient’s consciousness is lost with anesthetic drugs without tracheal intubation, but spontaneous breathing is preserved and the patient’s response to surgical stimulus stress is diminished or elim-inated. With the improvement of anesthesia techniques and surgical risk management and the promotion of ERAS concept, the application of this anesthesia method is increasingly used in some surgical fields. This type of anesthesia, which preserves voluntary breathing, is more difficult than general anesthesia with controlled breathing by tracheal intubation, and is a great challenge for anesthesiologists. However, this method makes patients more comfortable and memory-free while minimizing traumatic stress reactions and fast recovery. In this paper, we have collected and ana-lyzed the relevant studies in recent years, and now we review them as follows.
| [1] | Okuda, K. and Nakanishi, R. (2016) The Non-Intubated Anesthesia for Airway Surgery. Journal of Thoracic Disease, 8, 3414-3419. https://doi.org/10.21037/jtd.2016.11.101 |
| [2] | 孙营, 祁桂明, 蔡志芹, 等. 非气管插管静脉麻醉在消化内镜诊疗中的应用[J]. 世界最新医学信息文摘, 2016, 16(93): 5-6. |
| [3] | 吴竑鹏, 庄伟强, 陈琳. 盐酸纳布啡复合丙泊酚麻醉用于无痛宫腔镜手术中的麻醉效果和安全性研究[J]. 医疗装备, 2022, 35(21): 117-119. |
| [4] | 杨昌明, 丁怡萌, 何孟菊, 等. 瑞马唑仑联合布托啡诺用于宫腔镜诊刮术患者中的安全性及有效性研究[J]. 中国医学前沿杂志(电子版), 2023, 15(1): 46-49. |
| [5] | Huang, J., Qiu, Y., Chen, L., et al. (2017) Nonintubated Spontaneous Respiration Anesthesia for Tracheal Glomus Tumor. The Annals of Thoracic Surgery, 104, e161-e163. https://doi.org/10.1016/j.athoracsur.2017.02.028 |
| [6] | 信文启, 李爱香, 闫增. 不同麻醉方法用于膀胱镜检查术的效果[J]. 中华麻醉学杂志, 2015, 35(6): 767-768. |
| [7] | 邵超彦. 丙泊酚复合地佐辛麻醉用于膀胱镜检查术的效果[J]. 世界最新医学信息文摘, 2018, 18(71): 116-123. |
| [8] | 朱梅. 非气管插管下瑞芬太尼复合异丙酚麻醉在颈部淋巴结结核病灶清除术中的应用[J]. 长江大学学报(自科版), 2015, 12(18): 41-42. |
| [9] | 刘敏肖, 刘立永, 宋子贤, 等. 不同剂量右美托咪定复合瑞芬太尼和丙泊酚用于非气管插管烧伤患者麻醉效果的比较[J]. 中华麻醉学杂志, 2019, (4): 459-461. |
| [10] | 姚光, 甘务琼. 非插管静脉全身麻醉下行经皮介入封堵术治疗小儿先天性心脏病95例分析[J]. 中国医师进修杂志, 2010, 33(15): 45-46. |
| [11] | Kiss, G. and Castillo, M. (2015) Nonintubated Anesthesia in Thoracic Surgery: General Issues. Annals of Translational Medicine, 3, 110. |
| [12] | Janík, M., Juhos, P., Lu？eni？, M., et al. (2021) Non-Intubated Thoracoscopic Surgery—Pros and Cons. Frontiers in Surgery, 8, Article ID: 801718. https://doi.org/10.3389/fsurg.2021.801718 |
| [13] | Chiang, X.-H. and Lin, M.-W. (2021) Converting to Intubation during Non-Intubated Thoracic Surgery: Incidence, Indication, Technique, and Prevention. Frontiers in Surgery, 8, Arti-cle ID: 769850.
https://doi.org/10.3389/fsurg.2021.769850 |
| [14] | Tacconi, F. and Pompeo, E. (2016) Non-Intubated Video-Assisted Thoracic Surgery: Where Does Evidence Stand? Journal of Thoracic Disease, 8, S364-S375. https://doi.org/10.21037/jtd.2016.04.39 |
| [15] | Cai, L.-S., Bo, H., Hua, J., et al. (2021) Clinical Evaluation of the Rapid Recovery of Patients Who Underwent Video-Assisted Thoracoscopic Lung Surgery under Non-Intubated Anes-thesia. Annals of Translational Medicine, 9, 1783.
https://doi.org/10.21037/atm-21-6434 |
| [16] | Galvez, C, Navarro-Martinez, J., Bolufer, S., et al. (2017) Nonintubated Uniportal VATS Pulmonary Anatomical Resections. Journal of Visualized Surgery, 3, 120. https://doi.org/10.21037/jovs.2017.08.10 |
| [17] | Goulson, D.-T. and Fragneto, R.-Y. (2009) Anesthesia for Gastro-intestinal Endoscopic Procedures. Anesthesiology Clinics, 27, 71-85. https://doi.org/10.1016/j.anclin.2008.10.004 |
| [18] | Barnett, S.-R., Berzin, T., Sanaka, S., et al. (2013) Deep Sedation without Intubation for ERCP Is Appropriate in Healthier, Non-Obese Patients. Digestive Diseases and Sciences, 58, 3287-3292.
https://doi.org/10.1007/s10620-013-2783-x |
| [19] | Melis, V., Aldo, C., Dioscoridi, L., et al. (2022) Non-Intubated General Anesthesia in Prone Position for Advanced Biliopancreatic Therapeutic Endoscopy: A Single Tertiary Referral Center Experience. Saudi Journal of Anaesthesia, 16, 150-155. https://doi.org/10.4103/sja.sja_714_21 |
| [20] | 中华医学会消化内镜学分会, 中华医学会麻醉学分会. 中国消化内镜诊疗镇静/麻醉的专家共识意见[J]. 中华消化内镜杂志, 2014, 31(8): 421-428. |
| [21] | 中华医学会消化内镜学分会麻醉协作组. 常见消化内镜手术麻醉管理专家共识[J]. 临床麻醉学杂志, 2019, 35(2): 177-185. |
| [22] | 任婧, 邢春平, 王荣. 依托咪酯复合右美托咪定麻醉用于老年患者内镜逆行胰胆管造影术的效果及对认知功能的影响[J]. 中国实用医刊, 2022, 49(2): 53-57. |
| [23] | 张杰. 支气管镜操作麻醉方式及无痛支气管镜的相关问题[J]. 中华结核和呼吸杂志, 2015, 38(3): 162-163. |
| [24] | 邓小明, 王月兰, 冯艺, 等. (支)气管镜诊疗镇静/麻醉专家共识(2020版)[J]. 国际麻醉学与复苏杂志, 2021, 42(8): 785-794. |
| [25] | 袁媛, 张杰, 岳红丽, 等. 无痛支气管镜检查麻醉方法的初步探讨[J]. 中华结核和呼吸杂志, 2019, (2): 106-113. |
| [26] | 米智华, 胡乃琴, 王春林. 非气管插管全麻辅以HC可视喉镜在气管支架植入术中的应用[J]. 医学理论与实践, 2016, 29(3): 349-351. |
| [27] | Isamade, E., Agbo, D., Sagay, A., et al. (2013) Non-Intubated Ambulatory Anaesthesia for Diagnostic Gynaecological Laparoscopy. Journal of the West African College of Surgeons, 3, 14-24. |
| [28] | 刘瑶, 张重, 郭曲练, 等. 非气管插管全麻应用于婴幼儿小口畸形矫治术二例[J]. 临床麻醉学杂志, 2014, 30(4): 412. |
| [29] | 邓建冬, 程智刚, 向涛, 等. 右美托咪定复合舒芬太尼在非插管全麻下行输尿管镜钬激光碎石手术中的应用[J]. 中国现代手术学杂志, 2020, 24(4): 311-314. |
| [30] | 桑凤欣, 赵倩倩. 喉罩插管全身麻醉、非插管静脉全身麻醉与蛛网膜下腔阻滞用于宫腔镜手术的效果比较[J]. 中国实用医刊, 2019, (20): 73-75. |
| [31] | 王晓亮, 等. 小儿先天性心脏病介入治疗术的快通道麻醉[J]. 中国医师杂志, 2011, 13(6): 793-795. |
| [32] | Lundstr？m, S., Twycross, R., Mihalyo, M., et al. (2010) Propofol. Journal of Pain and Symptom Management, 40, 466-470. https://doi.org/10.1016/j.jpainsymman.2010.07.001 |
| [33] | Eleveld, D.-J., Colin, P., Absalom, A.-R., et al. (2018) Pharmacokinetic-Pharmacodynamic Model for Propofol for Broad Application in Anaesthesia and Sedation. British Journal of Anaesthesia, 120, 942-959.
https://doi.org/10.1016/j.bja.2018.01.018 |
| [34] | Stogiannou, D., Protopapas, A., Protopapas, A., et al. (2018) Is Propofol the Optimal Sedative in Gastrointestinal Endoscopy? Acta Gastro-Enterologica Belgica, 81, 520-524. |
| [35] | Qin, L.L., Ren, L., Wan, S.L., et al. (2017) Design, Synthesis, and Evaluation of Novel 2,6-Disubstituted Phenol Derivatives as General Anesthetics. Journal of Medicinal Chemistry, 60, 3606-3617.
https://doi.org/10.1021/acs.jmedchem.7b00254 |
| [36] | 黄凤南, 崔珊珊, 徐城, 等. 环泊酚联合小剂量舒芬太尼在门诊无痛胃肠镜检查中的麻醉效果与安全性研究[J]. 国际麻醉学与复苏杂志, 2022, 43(6): 616-620. |
| [37] | Nordt, S.-P. and Clark, R.-F. (1997) Midazolam: A Review of Therapeutic Uses and Toxicity. Journal of Emergency Medicine, 15, 357-365. https://doi.org/10.1016/S0736-4679(97)00022-X |
| [38] | Lee, A. and Shirley, M. (2021) Remimazolam: A Review in Procedural Sedation. Drugs, 81, 1193-1201.
https://doi.org/10.1007/s40265-021-01544-8 |
| [39] | 左荣华, 庄婧雯, 陈倩敏, 等. 瑞马唑仑复合阿芬太尼用于无痛胃镜检查的半数有效量[J]. 国际麻醉学与复苏杂志, 2022, 43(8): 813-817. |
| [40] | Zhang, Y., Dai, G., Xu, H., et al. (2022) Safety and Efficacy of Remimazolam Compared with Propofol in Induction of General Anesthesia: A Reply. Minerva Anestesiologica, 88, 194-195. https://doi.org/10.23736/S0375-9393.21.16169-3 |
| [41] | Afonso, J. and Reis, F. (2012) Dexmedetomidine: Current Role in Anesthesia and Intensive Care. Brazilian Journal of Anesthesiology, 62, 118-133. https://doi.org/10.1016/S0034-7094(12)70110-1 |
| [42] | Keating, G.-M. (2015) Dexmedetomidine: A Re-view of Its Use for Sedation in the Intensive Care Setting. Drugs, 75, 1119-1130. https://doi.org/10.1007/s40265-015-0419-5 |
| [43] | Scholz, J., Steinfath, M. and Schulz, M. (1996) Clinical Pharma-cokinetics of Alfentanil, Fentanyl and Sufentanil. An Update. Clinical Pharmacokinetics, 31, 275-292. https://doi.org/10.2165/00003088-199631040-00004 |
| [44] | 楚双萍, 彭文勇, 蔡振, 等. 阿芬太尼在胃镜检查患者麻醉诱导中的应用[J]. 中国医师杂志, 2022, 24(7): 1091-1094. |
| [45] | 魏华, 张乐, 李璐, 等. 瑞马唑仑复合阿芬太尼用于衰弱老年患者胃镜检查术的效果[J]. 中华麻醉学杂志, 2022, 42(6): 708-711. |
| [46] | Cortínez, L.-I. and Anderson, B.-J. (2021) Harnessing Remifentanil Adverse Effects. Pediatric Anesthesia, 31, 513-514.
https://doi.org/10.1111/pan.14159 |
| [47] | Sridharan, K. and Sivaramakrishnan, G. (2019) Comparison of Fentanyl, Remifentanil, Sufentanil and Alfentanil in Combination with Propofol for General Anesthesia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Current Clinical Pharmacology, 14, 116-124. https://doi.org/10.2174/1567201816666190313160438 |
| [48] | Steel, B.-J., Denholm, K.-A., Misra, U., et al. (2021) Remifentanil-Related Muscle Rigidity during Osteotomy Procedures. British Journal of Oral and Maxillofacial Surgery, 59, 615. https://doi.org/10.1016/j.bjoms.2020.11.024 |
| [49] | Maciejewski, D. (2012) Sufentanil in Anaesthesiology and Intensive Therapy. Anaesthesiology Intensive Therapy, 44, 35-41. |
| [50] | Babazade, R. and Turan, A. (2016) Pharma-cokinetic and Pharmacodynamic Evaluation of Sublingual Sufentanil in the Treatment of Post-Operative Pain. Expert Opinion on Drug Metabolism & Toxicology, 12, 217-224.
https://doi.org/10.1517/17425255.2016.1134487 |
| [51] | Porela-Tiihonen, S., Kokki, H. and Kokki, M. (2020) An Up-to-Date Overview of Sublingual Sufentanil for the Treatment of Moderate to Severe Pain. Expert Opinion on Phar-macotherapy, 21, 1407-1418.
https://doi.org/10.1080/14656566.2020.1766025 |
| [52] | Nishimura, M. (2019) High-Flow Nasal Cannula Oxygen Therapy Devices. Respiratory Care, 64, 735-742.
https://doi.org/10.4187/respcare.06718 |
| [53] | Gupta, S. (2020) Supraglottic Jet Oxygenation and Ventilation—A Novel Ventilation Technique. Indian Journal of Anaesthesia, 64, 11-17. https://doi.org/10.4103/ija.IJA_597_19 |
| [54] | 苏畅. 一种带支撑结构鼻氧管的制作及应用[J]. 中华现代护理杂志, 2020, 26(4): 441. |
| [55] | Xiao, Q.S., Yang, Y.Y., Zhou, Y.B., et al. (2016) Comparison of Nasopharyngeal Airway Device and Nasal Oxygen Tube in Obese Patients Undergoing Intravenous Anesthesia for Gastroscopy: A Prospective and Randomized Study. Gastroenterology Research and Practice, 2016, Article ID: 2641257. https://doi.org/10.1155/2016/2641257 |
| [56] | 朱康丽, 王东春, 刘宇, 等. 全身麻醉下经内镜逆行胰胆管造影术中气道管理[J]. 国际麻醉学与复苏杂志, 2017, 38(12): 1138-1142. |
| [57] | 高洁彦, 邓威, 杨蕊, 等. 右美托咪啶联合鼻咽通气道在无痛纤维支气管镜检查麻醉中的应用[J]. 现代实用医学, 2022, 34(3): 340-342. |
| [58] | 王强, 石虎, 杨花平. 静脉麻醉辅以口咽通气道通气应用于宫腔镜电切术的临床观察[J]. 中国基层医药, 2013, 20(16): 2416-2418. |
| [59] | Matsui, R., Wong, M. and Waters, B. (2020) Alternative Transoral Application of Nasopharyngeal Airways. Anesthesia Progress, 67, 39-44. https://doi.org/10.2344/anpr-66-03-04 |
| [60] | Jannu, A., Shekar, A., Balakrishna, R., et al. (2017) Advantages, Dis-advantages, Indications, Contraindications and Surgical Technique of Laryngeal Airway Mask. Archives of Craniofacial Surgery, 18, 223-229.
https://doi.org/10.7181/acfs.2017.18.4.223 |
| [61] | Li, X.-L., He, X.-B., Wan, L., et al. (2020) Comparison of Trache-al Intubation with Controlled Ventilation and Laryngeal Mask Airway with Spontaneous Ventilation for Thoracoscopic Bullectomy. Medicine, 99, e19704.
https://doi.org/10.1097/MD.0000000000019704 |
