面罩正压通气时于左下侧气管旁压迫食管对空气进入胃内的影响
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The effect of force applied to the left paratracheal oesophagus on air entry into the gastric antrum during positive-pressure ventilation using a facemask
背景与目的
在面罩正压通气过程中，压迫环状软骨被广泛应用于降低吸入性肺炎和胃内充气的风险，但其有效性仍存在争议。
方 法
在计划于全身麻醉下行择期手术的患者使用面罩进行正压通气时，我们分别在左下侧气管旁和环状软骨水平人工压迫食管，比较两种方法预防胃内充气的效果。签署知情同意书后，试验参与者被随机用密封信封分配到以下三组中的一组：以30 N压力于左下侧气管旁压迫食管 (气管旁组)；以30 N压力于环状软骨水平压迫食管 (环状软骨组)；或未压迫食管(对照组)。通过超声测量胃的横截面积和/或胃内是否存在气体阴影，评估正压通气前后胃内空气的注入情况。超声证实胃内进入空气的受试者比例作为主要结果。
结 果
每组纳入了30名患者。在面罩通气前，所有受试者的胃内均未见气体阴影。受试者面罩通气后，气管旁组未见气体阴影，环状软骨组出现6例，对照组出现8例(p = 0.012)。
结 论
面罩正压通气过程中，于左下侧气管旁水平人工压迫食管可阻止空气进入胃内，比压迫环状软骨处更有效。
原始文献摘要
Gautier N, Danklou J, Brichant JF, et al. The effect of force applied to the left paratracheal oesophagus on air entry into the gastric antrum during positive-pressure ventilation using a facemask.[J].Anaesthesia. 2019 Jan;74(1):22-28. doi: 10.1111/anae.14442.
Cricoid force is widely applied to decrease the risk of pulmonary aspiration and gastric antral insufflation of air during positive-pressure ventilation, yet its efficacy remains controversial. We compared manual oesophageal compression at the low left paratracheal and cricoid levels for the prevention of gastric antral air insufflations during positive-pressure ventilation by facemask in patients scheduled for elective surgery under general anaesthesia. After gaining written consent, participants were randomly allocated by sealed envelope to one of three groups: oesophageal compression by 30 N paratracheal force (paratracheal group); oesophageal compression by 30 N cricoid force (cricoid group); or no oesophageal compression (control group). Gastric insufflation of air was assessed before and after positive-pressure ventilation by ultrasound measurement of the antral cross-sectional area and/or presence of air artefacts in the antrum. The primary outcome measure was the proportion of participants with ultrasound evidence of gastric insufflation. We recruited 30 patients into each group. Before facemask ventilation, no air artefacts were visible in the antrum in any of the participants. After facemask ventilation of the participant’s lungs, no air artefacts were seen in the paratracheal group, compared with six subjects in the cricoid group and eight subjects in the control group (p = 0.012). Our results suggest that oesophageal compression can be achieved by the application of manual force at the low left paratracheal level and that this is more effective than cricoid force in preventing air entry into the gastric antrum during positive-pressure ventilation by facemask.
麻醉学文献进展分享
贵州医科大学高鸿教授课题组
翻译：冯玉蓉 编辑：何幼芹 审校：王贵龙