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摘要: 目的 分析鼻腔鼻窦疾病患者鼻内镜手术围手术期的气道管理流程，为加速患者康复、减少呼吸系统并发症提供临床依据。 方法 根据患者术前危险因素、肺功能检查等制定鼻内镜手术患者围手术期气道管理流程，对2019年3月－2020年5月进入气道管理流程的512例鼻科患者进行分析，观察患者术前气道干预前后肺功能改善程度及围手术期不良呼吸事件的发生情况。 结果 512例患者行肺功能检查，肺功能异常者265例，其中通气功能障碍者203例；支气管激发试验阳性者103例；支气管舒张试验阳性59例。给予肺功能异常者术前雾化吸入3~5 d后复查肺功能，主要观察指标较前改善，差异有统计学意义(P < 0.01)；给予患者个体化干预后行手术治疗，围手术期未出现呼吸不良事件。 结论 对鼻内镜手术患者进行围手术期的气道管理，改善肺功能，有利于降低围手术期风险。Abstract: Objective To evaluate the perioperative airway management process of nasal endoscopic surgery, and find clinical evidence for accelerating recovery and reducing respiratory complications. Methods The perioperative airway management process for nasal endoscopic surgery was developed according to the patient's preoperative risk factors and preoperative pulmonary function. 512 patients who entered the airway management process from March 2019 to May 2020 were included. The improvement of pulmonary function and the occurrence of adverse respiratory events during the perioperative period were analyzed. Results 265 of 512 patients showed abnormal pulmonary function, including 203 cases with ventilatory dysfunction; 103 cases with positive bronchial provocation test; 59 cases with positive bronchodilation test. Patients with abnormal lung function were treated with aerosol inhalation for 3 to 5 days before surgery, the pulmonary function indicators were greatly improved(P < 0.01). After individualized airway management, patients were then treated with surgery, and there was no perioperative dyspnea event. Conclusion Perioperative airway management can improve pulmonary function and reduce the risk of nasal endoscopic surgery.
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Key words:
- endoscopic surgery /
- peroperative period /
- airway management /
- pulmonary function
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表 1 肺功能异常患者治疗前后肺功能指标的改善情况
组别 FEV1%pre FEV1/FVC%pre MEF50%%pre MEF75%%pre MMEF%pre FVC%pre 治疗前 86.98±14.63 90.57±12.51 60.76±22.46 74.09±21.91 59.87±24.52 96.69±11.51 治疗后 91.76±15.38 93.43±11.83 66.71±22.47 81.87±21.41 66.61±24.70 103.08±7.12 t 4.55 5.99 11.27 6.97 8.25 4.43 P < 0.01 < 0.01 < 0.01 < 0.01 < 0.01 < 0.01 
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