湿化高流量鼻导管通气对全麻术后深麻醉下拔管时患者氧合状态与舒适度的影响  

The effects of humidified high flow nasal cannula on oxygenation status and comfort of patients during extubation under deep anesthesia after general anesthesia

作　　者：黎耀辉 曾彦茹[2] LI Yao-hui;ZENG Yan-ru(Department of Aneshesiology,Sixth Hospital of Pan Yu Guangzgou,Guangzhou 511442,Guangdong,China;不详)

机构地区：[1]广州市番禺区第六人民医院麻醉科,广东广州511442 [2]广州市第一人民医院麻醉科,广东广州510180

出　　处：《广东医学》2021年第9期1061-1065,共5页Guangdong Medical Journal

摘　　要：目的研究湿化高流量鼻导管通气(HFNC)对全麻术后深麻醉下拔出气管导管时患者氧合状态与舒适度的影响。方法选择择期气管插管全麻手术患者90例(ASAⅠ~Ⅱ级),根据不同麻醉深度下拔出气管导管的方法,将患者随机分成3组。A组(n=30)深麻醉下监测脑电双频指数(BIS)68~75时拔出气管导管,采用HFNC(广州HF807C),氧流量40~50 L/min,吸入氧浓度(FiO_(2))50%,温度34℃、湿度100%;B组(n=30)深麻醉下拔管条件同A组,经鼻传统方法给氧,流量3.0~4.0 L/min,FiO_(2)=100%;C组(n=30)完全清醒时BIS为90~98拔管,经鼻传统方法给氧同B组。观察记录患者进入麻醉恢复室(PACU)留观时患者平均动脉压(MAP)、心率(HR)、脉搏血氧饱和度(SpO_(2))、呼吸频率(RR)、麻醉深度(BIS),记录Ricker镇静-躁动评分;拔管时间、PACU留置时间及可能血流动力学波动、低氧血症、躁动、恶心呕吐、寒颤等不良反应。结果术后拔管时间A组和B组明显快于C组(P<0.05);Ricker镇静-躁动评分A组和B组明显低于C组(P<0.05);拔管后C组患者MAP、HR比A组和B组明显增高(P<0.05),A组与B组患者拔管期间更为安静(P<0.05),B组低氧血症和呼吸抑制需要面罩加压给氧人次达50%,显示B组明显多于A组和C组(P<0.05);C组患者呛咳达70.0%,恶心呕吐达23.3%,其不良反应明显多于A组和B组(P<0.05);综合满意舒适度评级A组(97%)明显高于B组(35%)和C组(30%)。结论全麻手术患者在PACU深麻醉下(BIS 68~75)拔出气管导管HFNC,可以减轻应激反应,改善患者氧合状态,提高SpO_(2)数值和患者舒适度,有利于促进患者早期康复,值得临床选用。Objective To explore the effects of humidified high flow nasal cannula(HFNC)on the oxygenation status and comfort of patients when the tracheal tube is pulled out under deep anesthesia after general anesthesia.Methods Ninety patients undergoing general anesthesia for tracheal intubation(ASAⅠtoⅡ)were randomly divided into three groups.In group A(n=30),the endotracheal catheter was pulled out when the bispectral index(BIS)was 68~75 under deep anesthesia,and HFNC(Guangzgou HF807C)was adopted with oxygen flow of 40~50 L/min,fraction of inspiration O_(2)(FiO_(2))of 50%,and temperature of 34℃.In group B(n=30),the endotracheal tube was pulled out when BIS was 68~75 under deep anesthesia,and oxygen was given via the traditional nasal method with oxygen flow of 3.0-4.0 L/min and FiO_(2) of 100%.Patients in group C(n=30)were extubated with BIS of 90~98 when were fully awake,and were given conventional nasal oxygen the same as in group B.MAP,HR,SpO_(2),RR,BIS,Riser sedation-restlessness score,extubation time,PACU dwell time,and adverse reactions such as hypoxemia,restlessness,nausea and vomiting,and shivering were recorded.Results Postoperative extubation times of group A and group B were fewer than that of group C(P<0.05).Riser sedation-restlessness scores of group A and group B were lower than that of group C(P<0.05).After extubation,MAP and HR in group C were significantly higher than those in group A and group B(P<0.05).Patients in group A and group B were quieter than those in group C during extubation(P<0.05).The incidences of hypoxemia and respiratory depression that required pressure oxygenation by mask in group B(50%)were higher than that in group A and group C(P<0.05).The incidences of coughing,restlessness,nausea and vomiting in group C were higher than that in group A and group B(P<0.05).The comprehensive satisfaction rating of group A(97%)was significantly higher than that of group B(35%)and group C(30%).Conclusion HFNC after extubation for patients under deep general anesthesia(BIS at 68~75)can reduce th

关 键 词：湿化高流量通气 全身麻醉 麻醉后监测治疗室 加速康复 

分 类 号：R614.2[医药卫生—麻醉学] R614[医药卫生—外科学]