经鼻高流量预充氧可保障老年患者全麻气管插管诱导期的安全  

Is pre-oxygenation with high-flow nasal oxygen safe?randomized control trial of 56 cases of elderly patients during induction of general anesthesia with endotracheal intubation

作　　者：蔡清香[1] 马武华[1] 吴财能[1] 刘慧慧[1] 王姝晨 张广防[3] CAI Qingxiang;MAWuhua;WU Caineng;LIU Huihui;WANG Shuchen;ZHANG Guangfang(Department of Anesthesiology,First Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510405,China;First Clinical Medical College of Guangzhou University of Chinese Medicine,Guangzhou 510006,China;Department of Anesthesiology,Guangdong Provincial Hospital of Chinese Medicine,Guangzhou 510120,China)

机构地区：[1]广州中医药大学第一附属医院麻醉科,广东广州510405 [2]广州中医药大学第一临床医学院,广东广州510006 [3]广东省中医院麻醉科,广东广州510120

出　　处：《南方医科大学学报》2022年第7期1069-1074,共6页Journal of Southern Medical University

基　　金：广东省科技厅社会发展项目(2017ZC0155)。

摘　　要：目的评估经鼻高流量预充氧在老年患者全麻气管插管诱导期的安全性研究。方法56例非困难气道老年患者,采用随机数字表法分为经鼻高流量吸氧组(HF组)和传统面罩经口鼻吸氧组(M组),28例/组。全麻气管插管诱导给药前预充氧5 min,HF组喉镜检查期间维持给氧,M组通气持续到喉镜检查。观察并记录两组患者基本资料,预充氧前(T1)、预充氧5 min(T2)及插管成功即刻(T3)的超声下胃窦横截面积(CSA)和动脉血气分析指标:PaO_(2)、PaCO_(2)、cSO_(2),窒息安全时间,插管时间,面罩通气的次数及术后并发症。结果两组患者的基本资料差异无统计学意义。预充氧5 min,两组患者的PaO_(2)和cSO_(2)均明显升高,且HF组PaO_(2)较M组明显(F=118.108 vs 9.511,P<0.05),插管成功后PaO_(2)和cSO_(2)均下降,HF组的PaO_(2)值较M组下降缓慢,且仍高于其T1时点,而M组的cSO_(2)值下降显著,低于其T1时点值。HF组窒息安全时间显著高于M组(t=5.305,P<0.05),且HF组面罩通气次数少于M组(χ^(2)=6.720,P<0.05)。两组插管后的PaCO_(2)值均增高,但两组比较差异无统计学意义(F=3.138,P>0.05),其余结果差异也无统计学意义(P>0.05)。结论经鼻高流量吸氧是一种安全简单有效的预充氧方式,与传统的面罩预充氧相比,能提高老年患者的动脉氧分压,延长患者窒息安全时间,可保障老年患者全麻诱导插管时气道管理的安全。Objective To evaluate the safety of preoxygenation with high-flow nasal oxygenation in elderly patients during induction of general anesthesia with endotracheal intubation.Methods Fifty-six elderly patients without difficult airway were randomized equally into high-flow nasal oxygen group(HF group)and conventional mask oxygen group(M group).Preoxygenation was performed for 5 min before induction of general anesthesia and endotracheal intubation.Oxygenation was maintained during laryngoscopy in HF group,and ventilation lasted until laryngoscopy in M group.For all the patients,the general data,cross-sectional area(CSA)of the gastric antrum measured by ultrasonography,arterial partial pressure of oxygen(PaO_(2)),arterial partial pressure of carbon dioxide(PaCO_(2))and arterial oxygen saturation(cSO_(2))were recorded before preoxygenation(T1),at 5 min of preoxygenation(T2)and immediately after intubation(T3).The safety time of asphyxia,intubation time,times of mask ventilation and postoperative complications were compared between the two groups.Results The general data were comparable between the two groups.After 5 min of preoxygenation,PaO_(2) and cSO_(2) were significantly increased in both groups,and PaO_(2) was significantly higher in HF group than in M group(F=118.108 vs 9.511,P<0.05).Both PaO_(2) and cSO_(2) decreased after intubation,but PaO_(2) decreased more slowly in HF group and still remained higher than that at T1;cSO_(2) decreased significantly in M group to a lower level than that at T1.Compared with those in M group,the patients in HF group showed a significantly longer safety time of asphyxia(t=5.305,P<0.05)with fewer times of mask ventilation(χ2=6.720,P<0.05).PaCO_(2) increased after intubation in both groups but was comparable between the two groups(F=3.138,P>0.05).Conclusion High-flow nasal oxygen is safe,simple and effective for pre-oxygenation,which,as compared with the conventional oxygen mask,improves arterial oxygen partial pressure and prolongs the safety time of asphyxia to ensure the safe

关 键 词：高流量吸氧 胃窦横截面积 窒息安全时间 气道管理 

分 类 号：R614.2[医药卫生—麻醉学]