Theeffectofheadrotationonefficiencyof face maskventilation in anaesthetised apnoeic adults: A randomised,crossoverstudy.

頭側位對麻醉誘導後成年人的麵罩通氣效率的影響：一項隨機交叉研究

BACKGROUND 背景

Upper airway obstruction occurs commonly after induction of general anaesthesia. It is the major cause of difficult maskventilation.

上呼吸道阻塞通常在全身麻醉誘導後發生，是麵罩通氣困難的主要原因。

OBJECTIVES 目的

The aim of this study was to determine whetherheadrotationimproves theefficiencyof maskventilationof anaesthetised apnoeic adults.

本研究的目的是確定頭側位是否能提高麻醉誘導後存在窒息的成年人的麵罩通氣效率。

INTERVENTIONS 幹預

Once apnoeic after induction of general anaesthesia, face maskventilationbegan with pressure controlledventilation, at a peak inspiratory pressure of 15 cmH2O. Each patient was ventilated for three 1-min intervals with theheadposition alternated every minute: group A, maskventilationwas performed with a neutralheadposition for 1 min, followed by an axialheadposition rotated 45° to the right for 1 min and then returned to the neutral position for another 1 min. In group B, the sequence ofheadpositioning was rotated → neutral → rotated.

一旦全身麻醉誘導後出現窒息，即選擇壓力控製通氣模式、吸氣峰壓15 cmH2O進行麵罩通氣。每個患者麵罩通氣3分鍾，其中每隔1分鍾進行頭位變換。A組：頭正位通氣1分鍾，接下來頭右側旋轉45°進行通氣1分鍾，然後轉至頭正位通氣1分鍾。B組：通氣時頭位的順序為：側位-正位-側位。

RESULTS 結果

Two patients were excluded due to protocol violation; thus, data from 38 patients were analysed. The mean expiratory tidal volume was significantly higher in the rotatedheadposition than in the neutral position (612.6 vs. 544.0 ml: difference [95% confidence interval], 68.6 [46.8 to 90.4] ml, P < 0.0001).

兩位患者因違反計劃書被排除，因此，我們針對38例患者的資料進行分析。頭側位較頭正位時平均呼氣潮氣量明顯增高(612.6 vs. 544.0ml，差異[95%可信區間]，68.6 [46.8 至 90.4] ml，P < 0.0001)。

CONCLUSION 結論

Head rotation of 45° in anaesthetised apnoeic adults significantly increases the efficiency of mask ventilation compared with the neutral head position.Headrotationis an effective alternative to improve maskventilationif airway obstruction is encountered.

在麻醉窒息的患者中，頭側位45 °較頭正位明顯增加麵罩通氣量。遇到氣道阻塞時，頭位旋轉可以作為提高麵罩通氣量的一種有效的方法。

審校 曹廣慧