高流量鼻导管吸氧预防老年患者内镜逆行胰胆管造影手术中低氧血症的效果  

Effect of high flow nasal catheter oxygen to prevent hypoxemia in endoscopic retrograde cholangiopancreatography surgery in aged

作　　者：陈宁 宋丹丹 裘治慧 崔波 刁玉刚 Chen Ning;Song Dandan;Qiu Zhihui;Cui Bo;Diao Yugang(Department of Anesthesiology,Northern Theater Command General Hospital,Shenyang 110016,China)

机构地区：[1]北部战区总医院麻醉科,沈阳110016

出　　处：《中华医学杂志》2023年第41期3273-3278,共6页National Medical Journal of China

基　　金：辽宁省民生科技计划(2021JH2/10300011)

摘　　要：目的探讨高流量鼻导管吸氧预防老年患者内镜逆行胰胆管造影(ERCP)手术中低氧血症的效果。方法前瞻性选择2021年9月至2022年9月北部战区总医院择期行ERCP手术的老年患者116例(年龄≥70岁),按随机数字表法将患者分为普通鼻导管吸氧组[C组,男31例,女27例,年龄(79.8±6.4)岁]和高流量鼻导管吸氧组[H组,男33例,女25例,年龄(81.4±6.7)岁],每组58例。所有患者均采用靶控输注丙泊酚-瑞芬太尼监测麻醉。主要观察指标为两组患者术中亚临床低氧血症[90%≤血氧饱和度(SpO_(2))<95%,持续时间>5 s]、低氧血症(75%≤SpO_(2)<90%,5 s<持续时间≤60 s)和严重低氧血症(SpO_(2)<75%或SpO_(2)<90%,持续时间>60 s)发生率;次要观察指标为两组患者在麻醉诱导前(T_(0))、麻醉诱导后即刻(T_(1))、进镜时(T_(2))、十二指肠乳头插管时(T_(3))、退镜时(T_(4))、术后苏醒时(T_(5))不同时点的SpO_(2),以及在T_(0)、诱导后15 min和T_(5)时点的动脉血氧分压(PaO_(2))、二氧化碳分压(PaCO_(2))及酸碱度(pH)值。结果C组、H组患者术中亚临床低氧血症发生率分别为12.0%(7/58)、3.4%(2/58),差异无统计学意义(P=0.165);H组患者术中低氧血症发生率为8.6%(5/58),明显低于C组的31.0%(18/58)(P=0.003);两组患者术中均未发生严重低氧血症。H组患者在T_(1)、T_(2)、T_(3)、T_(4)时点的SpO_(2)分别为(98.2±0.9)%、(98.2±0.9)%、(97.8±1.7)%、(97.7±1.7)%,均高于C组的(96.8±2.1)%、(96.4±3.0)%、(96.1±2.9)%、(96.4±3.4)%(均P<0.05)。H组患者诱导后15 min的PaO_(2)为(240.5±46.7)mmHg(1 mmHg=0.133 kPa),高于C组的(170.6±33.4)mmHg(P<0.001);两组患者各时点pH值及PaCO_(2)比较,差异均无统计学意义(均P>0.05)。结论高流量鼻导管吸氧可以有效降低老年患者ERCP术中低氧血症的发生率。Objective To explore the effect of high-flow nasal catheter oxygen inhalation in preventing hypoxemia during endoscopic retrograde cholangiopancreatography(ERCP)surgery in elderly patients.Methods From September 2021 to September 2022,116 elderly patients(aged≥70 years)who underwent elective ERCP in the Northern Theater General Hospital were prospectively selected,then divided into general nasal catheter oxygen inhalation group[group C,31 males and 27 females,aged(79.8±6.4)years]and high-flow nasal catheter oxygen inhalation group[group H,33 males and 25 females,aged(81.4±6.7)years],with 58 patients in each group.All patients were monitored for anesthesia by target-controlled infusion of propofol and remifentanil.The main outcome index was the incidence of intraoperative subclinical hypoxemia(90%≤SpO_(2)<95%,duration>5 s),hypoxemia(75%<SpO_(2)<90%,5 s<duration≤60 s)and severe hypoxemia(SpO_(2)<75%or SpO_(2)<90%,duration>60 s).Secondary observation measures were SpO_(2)from T_(0)to T_(5)(T_(0),before anesthesia induction;T_(1),immediately after anesthesia induction;T_(2),endoscopic introduction;T_(3),duodenal papula intubation;T_(4),endoscopic withdrawal;T_(5),postoperative awakening),the arterial oxygen partial pressure(PaO_(2)),carbon dioxide partial pressure(PaCO_(2))and pH at T_(0),15 min after the induction and T_(5).Results The incidence of intraoperative subclinical hypoxemia in group C and group H was 12.0%(7/58)and 3.4%(2/58)respectively,which showed no significant statistical difference(P=0.165)from each other.The incidence of intraoperative hypoxemia in group H was 8.6%(5/58),which was significantly lower than 31.0%(18/58)of group C(P=0.003).Neither group had intraoperative severe hypoxemia.SpO_(2)of group H were(98.2±0.9)%,(98.2±0.9)%,(97.8±1.7)%and(97.7±1.7)%at T_(1),T_(2),T_(3),T_(4),which were higher than(96.8±2.1)%,(96.4±3.0)%,(96.1±2.9)%and(96.4±3.4)%in group C(all P<0.05).PaO_(2)at 15 min after induction in group H was(240.5±46.7)mmHg(1 mmHg=0.133 kPa),which was higher than that

关 键 词：老年人 内镜逆行胰胆管造影 经鼻高流量吸氧 监测麻醉 

分 类 号：R614[医药卫生—麻醉学]