经鼻高流量吸氧对预充氧及安全窒息时限的影响  

Clinical Effects of High Flow Nasal Cannular Insufflation on Preoxygenation and Extension of Safe Apneic Period

作　　者：彭俊[1] 陈羽青 叶健鸿[2] 杨雪莹[1] 彭书崚[1] 左志义 PENG Jun;CHEN Yu-qin;YE Jian-hong;YANG Xue-ying;PENG Shu-ling;ZUO Zhi-yi(The department of Anesthesiology,Sun Yat-sen Memorial Hospital,Sun Yat-sen University,Guangzhou 510120,China;The department of Anesthesiology,The first Affiliated Hospital,Sun Yat-sen University,Guangzhou 510080,China)

机构地区：[1]中山大学孙逸仙纪念医院麻醉科,广东广州510120 [2]中山大学附属第一医院麻醉科,广东广州510080

出　　处：《中山大学学报（医学版）》2018年第2期263-268,共6页Journal of Sun Yat-Sen University:Medical Sciences

摘　　要：【目的】评价经鼻高流量吸氧在全麻诱导前行预充氧的有效性及在插管期延长"安全窒息时限"的效果。【方法】随机将80例非困难气道病例纳入全麻面罩组(FM)、全麻面罩复合经鼻高流量吸氧组(FM+HFNCI)、经鼻高流量吸氧组(HFNCI)以及经鼻高流量吸氧复合鼻咽通气道组(HFNCI+NPA)。麻醉诱导前预充氧阶段,FM及FM+HFNCI组经全麻面罩而HFNCI及HFNCI+NPA组经鼻导管行预充氧;在气管插管期,除FM组外,余患者均接受经鼻高流量氧吹入。记录不同时点血氧分压、血氧饱和度、心率及血压。【结果】预充氧结束时,PaO_2值、SaO_2值在各组间差异无统计学意义(P>0.05)。窒息插管期,PaO_2值在FM组下降明显,而在HFNCI+NPA组上升;FM组ΔPaO_2值最大(均数为-5.4 k Pa),与其余组比较(ΔPaO_2值均数在FM+HFNCI、HFNCI及HFNCI+NPA组分别为-0.5、-0.8、1.4 k Pa)差异有统计学意义(P<0.001)。插管成功时FM、FM+HFNCI、HFNCI、HFNCI+NPA组PaO_2值(均数分别为46.7、48.3、37.7、43.7 k Pa)、SaO_2值(均数分别为99.7%、99.8%、99.4%、99.7%)均远高于各自安全低限值。【结论】HFNCI用于非困难气道病例,麻醉诱导前预充氧有效性高、可能延长"安全窒息时限",提高围插管期安全;为达最佳氧合效果,实施HFNCI时应保证气道通畅。【Objective】To assess the effects of high flow nasal cannular insufflation(HFNCI)on preoxygenation and extension of safe apneic period during tracheal intubation.【Methods】Patients were randomly allocated into facemask(FM),facemask plus HFNCI(FM+HFNCI),HFNCI and HFNCI plus nasopharyngeal airway(HFNCI+NPA)groups.Facemask was adopted in FM and FM+HFNCI groups,while HFNCI was used in HFNCI and HFNCI+NPA groups for preoxygenation.All patients except for those in FM group received HFNCI during tracheal intubation.PaO2,SaO2,HR and MAP were recorded and analyzed.【Results】There was no significant difference in PaO2and SaO2after preoxygenation among groups(P>0.05).During apneic tracheal intubation period,PaO2decreased significantly in FM group while increased in HFNCI+NPA group.TheΔPaO2in FM group(Mean value was-5.4kPa)was significantly bigger than those in other groups(Mean values in FM+HFNCI,HFNCI,and HFNCI+NPA groups were-0.5,-0.8and1.4kPa,respectively(P<0.001).All values at the success of tracheal intubation were much above the safe limits.【Conclusion】HFNCI provides effective preoxygenation and may extend safe apneic period in patients with patent airway.

关 键 词：经鼻高流量吸氧 预充氧 安全窒息时限 

分 类 号：R371[医药卫生—病原生物学]