经鼻导管高流量氧疗技术在老年胃肠外科病人麻醉诱导中的应用

doi:10.3969/j.issn.1003-9198.2021.11.009

摘要/Abstract

摘要： 目的研究经鼻导管高流量氧疗(high-flow nasal cannula oxygen therapy,HFNC)在老年胃肠外科病人麻醉诱导中的应用。方法随机将80例老年胃肠外科病人分为HFNC组与面罩组。HFNC组在麻醉诱导全程采用HFNC直至完成气管插管,面罩组经无创呼吸面罩预充氧、定容机械通气后完成气管插管。依次记录病人完成动脉穿刺时(T0)、预充氧5 min后(T1)、注射顺式阿曲库铵3 min后(T2)和完成气管插管即刻(T3)的心率(HR)、平均动脉压(MAP)、SpO₂、PaO₂及PaCO₂。病人自主呼吸消失至完成气管插管的时期(即T2至T3)定义为窒息插管期。结果 2组病人T0、T1、T2和T3时刻HR、MAP、SpO₂差异均无统计学意义; HFNC组T1时刻PaO₂显著高于面罩组(P<0.05);窒息插管期HFNC组PaO₂下降值和PaCO₂升高值均显著小于面罩组(P<0.05);HFNC组病人舒适度显著高于面罩组(P<0.05)。结论 HFNC用于老年病人围插管期预充氧效果好,窒息插管期血氧分压下降幅度小,且不增加二氧化碳的蓄积,病人舒适度高,值得在临床上推广。

关键词: 高流量氧疗, 呼吸面罩, 预充氧, 安全窒息时限

Abstract: Objective To investigate the application of high-flow nasal cannula oxygen therapy (HFNC) for anesthesia induction in the elderly patients undergoing gastrointestinal surgery. Methods Eighty elderly patients undergoing elective gastrointestinal surgery were randomly equally allocated into the HFNC group and the face mask group. In the HFNC group, high-flow oxygen inhalation through the nasal catheter was performed until endotracheal intubation was completed. While in the face mask group, endotracheal intubation was achieved after pre-oxygenation and mechanical ventilation through non-invasive mask. The heart rate (HR),mean arterial pressure (MAP), pulse oxygen saturation (SpO₂), partial pressure of oxygen in artery (PaO₂) and partial pressure of carbon dioxide in artery (PaCO₂) were recorded at the time of arterial puncture completed (T0), 5 minutes after pre-oxygenation (T1), 3 minutes after cis-atracurium injection (T2), and immediately after the endotracheal intubation (T3). The apneic tracheal intubation period was defined from apnea to the completion of endotracheal intubation (T2 to T3). Results There was no significant difference in vital signs between the two groups. The level of PaO₂ was significantly higher in the HFNC group than that in the face mask group at T1 (P<0.05). During apneic tracheal intubation period, the decrease of PaO₂ and the increase of PaCO₂ in the HFNC group were significantly lower than those in the face mask group (P<0.05). The comfort level in the HFNC group was significantly higher than that in the face mask group (P<0.05). Conclusions HFNC provides effective pre-oxygenation, slight decrease of PaO₂ during apneic tracheal intubation period without CO₂ accumulation and is more comfortable for the elderly patients undergoing gastrointestinal surgery.

Key words: high-flow nasal cannula oxygen therapy, face mask, pre-oxygenation, safe apneic period

中图分类号:

R 614.2

熊静薇, 张利东, 嵇晴, 刘杨. 经鼻导管高流量氧疗技术在老年胃肠外科病人麻醉诱导中的应用[J]. 实用老年医学, 2021, 35(11): 1140-1143.

XIONG Jing-wei, ZHANG Li-dong, JI Qing, LIU Yang. Application of high-flow nasal cannula oxygen therapy for anesthesia induction in elderly patients undergoing gastrointestinal surgery[J]. Practical Geriatrics, 2021, 35(11): 1140-1143.

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