湿化高流量鼻导管通气在全麻下小儿气道异物硬支气管镜窒息插管期预充氧应用的安全性  

Safety of humidified high-flow nasal cannula for preoxygenation during asphyxia in rigid endoscopic intubation under general anesthesia in children with airway foreign body

作　　者：吴立新 陈媛珍 赵宗辉 马星钢[1] WU Li-xin;CHEN Yuan-zhen;ZHAO Zong-hui;MA Xing-gang(Surgery Anesthesia Center,Shenzhen Children's Hospital,Shenzhen 518038,Guangdong,China)

机构地区：[1]深圳市儿童医院手术麻醉中心,广东深圳518038

出　　处：《广东医学》2021年第9期1052-1055,共4页Guangdong Medical Journal

摘　　要：目的对全麻下行气道异物取出术的患儿,诱导期使用湿化高流量鼻导管通气(HFNC)预充氧,评价该方法在硬支气管镜窒息插管期预充氧的有效性及安全性。方法随机将40例3岁以下小儿气道异物取出术且非困难气道病例纳入全麻面罩组(FM组)、经鼻高流量吸氧组(HF组)。麻醉诱导预充氧阶段,FM组经全麻面罩预充氧,而HF组经HFNC预充氧。记录不同时间点[预充氧结束时(T1)和插管成功时(T2)]血氧分压(PaO_(2))、血氧饱和度(SaO_(2))、心率及血压。结果两组患儿麻醉诱导平稳,手术医师置入硬支气管镜顺利。T1和T2时点窒息插管期时间、HR、MAP波动变化幅度差异无统计学意义(P>0.05)。两组患儿在T1和T2时点的PaO_(2)、SaO_(2)差异无统计学意义(P>0.05),且均在安全值范围内。诱导期两组均无需面罩手法辅助通气的病例。围插管期两组均无不良事件(心律失常、鼻腔出血、口咽腔出血、胃肠胀气、术后喉痉挛)的情况发生。研究过程中未发现低氧血症(SpO_(2)<90%)的病例。结论在小儿气道异物硬支气管镜窒息插管病例全麻诱导期使用HFNC预充氧安全有效,可在小儿气道异物取出术中规范化选用。Objective To evaluate the efficacy and safety of humidified high-flow nasal catheter ventilation(HFNC)preoxygenation,it was administered during induction period of general anesthesia and asphyxia in rigid bronchoscopic intubation in children undergoing airway foreign body removal.Methods Forty children under 3 years old who underwent airway foreign body surgery and had non-difficult airway were randomly allocated to the face mask group under general anesthesia(FM group)or the high-flow nasal oxygenation group(HF group).During the preoxygenation stage in anesthesia induction,the FM group was preoxygenated by mask under general anesthesia,while the HF group was preoxygenated by HFNC.Partial pressure of oxygen,oxygen saturation in blood,heart rate and blood pressure were recorded at different time points.Results At the end of preoxygenation(T1)and after successful intubation(T2),PaO_(2) and SaO_(2) in the two groups were within a safe range,and there was no significant difference between the two groups(P>0.05).In the period of foreign body removal under intubation,there was no statistical difference in the fluctuation amplitude of HR or MAP between the two groups,and no adverse events occurred.Conclusion HFNC is safe and effective for preoxygenation during induction of general anesthesia and asphyxia in rigid bronchoscopic intubation in children receiving foreign body removal,and provides a standardized choice during removal of airway foreign body in children.

关 键 词：湿化高流量鼻导管通气 预充氧 窒息安全时间 气道异物 

分 类 号：R459.6[医药卫生—治疗学] R614[医药卫生—临床医学]