加温湿化高流量鼻导管吸氧可减少老年患者麻醉复苏期缺氧事件发生  

High-flow nasal cannula oxygen therapy can reduce occurrence of hypoxia in elderly patients during anesthesia recovery

作　　者：许立倩[1] 魏宁 单美娟[1] 汪子怡 叶天成 梁赛珍[1] 李乐 朱强[1] 何路遥 白建杰 陈碧霞[1] 徐金东[1,2] XU Liqian;WEI Ning;SHAN Meijuan;WANG Ziyi;YE Tiancheng;LIANG Saizhen;LI Le;ZHU Qiang;HE Luyao;BAI Jianjie;CHENG Bixia;XU Jindong(Department of Anesthesiology,Guangdong Provincial People's Hospital and Guangdong Academy of Medical Science,Guangzhou 510080,China;Second Clinical Medical College,Southern Medical University,Southern Medical University,Guangzhou 510515,China;First Clinical Medical College,Southern Medical University,Guangzhou 510515,China)

机构地区：[1]广东省人民医院/广东省医学科学院麻醉科,广东广州510080 [2]南方医科大学第二临床医学院,广东广州510515 [3]南方医科大学第一临床医学院,广东广州510515

出　　处：《南方医科大学学报》2021年第8期1265-1269,共5页Journal of Southern Medical University

基　　金：广东省医学科研基金(A2020037);广州市科技计划项目(202102080093)。

摘　　要：目的探讨加温湿化高流量鼻导管吸氧在老年患者麻醉复苏期的应用的效果。方法纳入178例行择期非心脏手术老年患者,采用SPSS 20.0软件生成数字随机序列,将患者随机分为加温湿化高流量鼻导管吸氧组(H组)和常规经鼻导管吸氧组(N组),89例/组。所有患者送入麻醉复苏室后按复苏室常规流程行麻醉后复苏,气管导管拔除后H组给予加温湿化高流量鼻导管吸氧,N组给予常规鼻导管吸氧,两组均于吸氧10 min后行动脉血气分析并记录相关呼吸指标;吸氧期间观察并记录患者有无缺氧发生(氧饱和度<90%)及发生次数,是否再插管及不良反应(非计划入ICU,呕吐、误吸等)。结果两组患者均在麻醉复苏室安全复苏并送回病房,其中仅1例常规鼻导管吸氧的患者需再次气管插管。H组与N组比较:缺氧事件发生率(3.4%vs.11.2%,P=0.044),动脉血氧分压[(161.96±51.21)mmHg vs.(114.35±43.60)mmHg,P<0.001],氧合指数[(398.76±231.86)vs.(324.10±194.16),P=0.021]。两组患者的平均呼吸频率、动脉血二氧化碳分压、血氧饱和度差异均无统计学差异。结论加温湿化高流量鼻导管吸氧治疗应用于老年患者麻醉复苏期安全、效果良好,可减少气管导管拔除后缺氧事件的发生,提高动脉血氧分压,改善氧合。Objective To explore the effect of high-flow nasal cannula(HFNC)oxygen therapy in elderly patients during anesthesia recovery.Method A total of 178 elderly patients undergoing elective non-cardiac surgeries were randomly assigned into HFNC oxygen therapy group(group H)or nasal cannula oxygen therapy group(group N),with 89 patients in each group.All the patients were admitted in postanesthesia care unit(PACU)after the surgery for recovery following the routine procedure.After trachea extubation,the patients in group H received HFNC oxygen therapy and those in group N had nasal cannula oxygen therapy.In both groups,arterial blood gas analysis was performed at 10 min after oxygen inhalation and the respiratory parameters were recorded.During oxygen inhalation,the occurrence and frequency of hypoxia(oxygen saturation<90%),trachea reintubation and adverse events(unplanned admission to ICU,vomiting,aspiration,etc.)were recorded.Results All the patients recovered safely from anesthesia in the PACU and subsequently received routine care,and only 1 patient in group N required trachea reintubation.Compared with those in group N,that patients in group H had a significantly lower incidence of hypoxia(3.4%vs 11.2%,P=0.044),a higher arterial partial pressure of oxygen(161.96±51.21 vs 114.35±43.60 mmHg,P<0.001),and a higher oxygenation index(398.76±231.86 vs 324.10±194.16,P=0.021).The mean respiratory rate,arterial partial pressure of carbon dioxide and blood oxygen saturation were all comparable between the two groups.Conclusion HFNC oxygen therapy during anesthesia recovery is safe and effective in elderly patients and can reduce the occurrence of hypoxia after tracheal extubation and improve arterial partial pressure of oxygen and oxygenation.

关 键 词：加温湿化高流量鼻导管 麻醉复苏 老年患者 

分 类 号：R614[医药卫生—麻醉学]