湿化高流量鼻导管氧疗在无痛消化内镜诊疗中的应用  

The application of humidified high flow nasal cannula in gastrointestinal endoscopy procedures

作　　者：康茵[1] 蔡彬 朱毅[1] 崔灿[1] 胡家祺[1] 韦锦锋 毛松松[1] 王春晓[1] 王晟[1,2] KANG Yin;CAI Bin;ZHU Yi;CUI Can;HU Jiaqi;WEI Jinfeng;MAO Songsong;WANG Chunxiao;WANG Sheng(Department of Anesthesiology,Guangdong Provincial People’s Hospital,Guangdong Academy of Medical Sciences,Guangzhou 510080,China)

机构地区：[1]广东省人民医院广东省医学科学院麻醉科,广州市510080 [2]林芝市人民医院

出　　处：《临床麻醉学杂志》2020年第9期890-893,共4页Journal of Clinical Anesthesiology

基　　金：广东省医学科学技术研究基金(B2018025);广东省医学科学技术研究基金(B2020016)。

摘　　要：目的探讨湿化高流量鼻导管氧疗(HHFNC)用于无痛消化内镜诊疗的临床效果和安全性。方法择期行无痛消化内镜诊疗的患者200例,男111例,女89例,年龄18~80岁,BMI 18~30 kg/m^2,ASAⅠ—Ⅲ级,根据随机数字表将患者分为两组:普通鼻导管氧疗组(C组)和HHFNC组(H组)。C组通过鼻导管吸入氧气5 L/min。H组通过HHFNC系统(PT101AZ)吸入空氧混合气体50 L/min,FiO 240%。记录术中最低SpO 2、经皮二氧化碳分压(PtcCO 2)、无创呼吸支持;丙泊酚用量、内镜时间和呼之睁眼时间;低氧血症、高血压、低血压、心动过速、心动过缓、恶心呕吐等不良反应情况。结果与C组比较,H组术中最低SpO 2明显升高(P<0.05),无创呼吸支持明显减少(P<0.05),低氧血症发生率明显降低(P<0.05),心动过缓发生率明显升高(P<0.05)。两组PtcCO 2、丙泊酚用量、内镜时间、呼之睁眼时间、高血压、低血压、心动过速、恶心呕吐差异均无统计学意义。结论HHFNC用于无痛消化内镜可改善氧合和降低气道干预需求。Objective To assess clinical efficacy and safety of humidified high flow nasal cannula(HHFNC)in patients undergoing deep sedation for gastrointestinal endoscopy procedures.Methods A total of 200 patients scheduled for GI endoscopy under deep sedation with propofol,111 males and 89 females,aged 18-80 years,BMI 18-30 kg/m^2,ASA physical statusⅠ-Ⅲ,were randomly divided according with random number table to receive oxygen therapy through a nasal cannula(group C)or a HHFNC system(group H).Group C was inhaled 5 L/min of oxygen through nasal cannula,and group H was inhaled 50 L/min of air-oxygen mixed gas through HHFNC system(PT101AZ),and FiO 2 was 40%.The lowest SpO 2,transcutaneous pressure of carbon dioxide(PtcCO 2),patients’requirement for respiratory support,the amount of propofol,the time of the procedure,the time to open the eyes,incidence of hypoxia,hypertension,hypotension,tachycardia,bradycardia,nausea and vomiting and other adverse events were recorded during the procedures.Results Comparison with group C,the lowest SpO 2 in group H was significantly increased(P<0.05),the need for noninvasive respiratory support was significantly reduced(P<0.05),the incidence of hypoxic events was significantly decreased(P<0.05),and the incidence of transient bradycardia was significantly increased(P<0.05).There were no differences between the groups in PtcCO 2,total propofol dose,procedure time,the time to open the eyes,hypertension,hypotension,tachycardia,post-procedure nausea or vomiting.Conclusion HHFNC optimized oxygenation and reduced the requirement for airway assist maneuvers in patients undergoing GI endoscopy procedures with deep sedation.

关 键 词：湿化高流量鼻导管氧疗 无痛内镜 低氧血症 氧合 丙泊酚 

分 类 号：R614[医药卫生—麻醉学]