湿化高流量鼻导管通气在≥80岁老年ERCP术患者中的价值  

Value of humidified high flow nasal catheter ventilation in elderly patients≥80 years of age undergoing ERCP

作　　者：雷达[1] 杨蕊 王钢[1] 李永利[1] 王涛[1] LEI Da;YANG Rui;WANG Gang;LI Yongli;WANG Tao(The Second Department of Hepatobiliary Pancreatic and Splenic Surgery,Baoji Central Hospital,Baoji,Shaanxi 721008,China)

机构地区：[1]宝鸡市中心医院肝胆胰脾外科二科,陕西宝鸡721008

出　　处：《检验医学与临床》2023年第14期2070-2074,共5页Laboratory Medicine and Clinic

摘　　要：目的研究湿化高流量鼻导管通气在≥80岁老年经内镜逆行性胰胆管造影(ERCP)术患者中的价值。方法选取2019年1月至2022年1月在该院行ERCP术联合经十二指肠镜乳头切开取石术治疗的100例胆总管结石患者(≥80岁)作为研究对象,采用单纯随机抽样法分为观察组和对照组,每组各50例。观察组患者采用湿化高流量鼻导管通气,对照组患者采用传统鼻导管吸氧。比较两组患者围术期指标(手术时间、麻醉时间、丙泊酚用量);比较两组患者麻醉前(T0)、进镜入咽部(T1)、麻醉后30 min(T2)、退镜时(T3)、苏醒时(T4)的心率(HR)、呼吸频率(RR)、平均动脉压(MAP)、脉搏血氧饱和度(SpO_(2))水平;比较两组患者T0、T2、T4的动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))、pH值;比较两组患者低氧血症发生情况。结果两组患者手术时间、麻醉时间比较,差异均无统计学意义(P>0.05);观察组患者丙泊酚用量多于对照组,差异有统计学意义(P<0.05)。两组患者各时点HR、RR、MAP比较,差异均无统计学意义(P>0.05);观察组患者T1、T2、T3 SpO_(2)水平均高于对照组,差异均有统计学意义(P<0.05)。两组患者T0、T2、T4 PaO_(2)、pH值比较,差异均无统计学意义(P>0.05);观察组患者T2 PaCO_(2)水平高于对照组,差异有统计学意义(P<0.05)。观察组患者低氧血症发生率明显低于对照组,差异有统计学意义(P<0.05)。结论与传统鼻导管吸氧比较,湿化高流量鼻导管通气在≥80岁老年ERCP术患者中有利于降低低氧血症发生率,保持术中SpO_(2)平稳,但如果ERCP术时间延长,易导致PaCO_(2)水平升高,增加CO_(2)潴留的风险。Objective To investigate the value of humidified high flow nasal catheter ventilation in elderly patients≥80 years old undergoing endoscopic retrograde cholangiopancreatography(ERCP).Methods A total of 100 patients(≥80 years old)with common bile duct stones who underwent ERCP combined with endoscopic papilla lithotomy in the hospital from January 2019 to January 2022 were selected as the research objects.They were divided into observation group and control group by simple random sampling method,with 50 cases in each group.Patients in the observation group received humidified high flow nasal catheter ventilation,while patients in the control group received traditional nasal catheter oxygen inhalation.The perioperative indicators(operation time,anesthesia time,propofol dosage)were compared between the 2 groups.The heart rate(HR),respiratory rate(RR),mean arterial pressure(MAP)and pulse oxygen saturation(SpO_(2))levels were compared between the 2 groups before anesthesia(T0),into the pharynx(T1),30 min after anesthesia(T2),withdrawal(T3)and recovery(T4).The arterial partial pressure of oxygen(PaO_(2)),arterial partial pressure of carbon dioxide(PaCO_(2))and pH value at T0,T2 and T4 were compared between the 2 groups.The incidence of hypoxemia was compared between the 2 groups.Results There was no significant difference in operation time and anesthesia time between the 2 groups(P>0.05).The dosage of propofol in the observation group was more than that in the control group,and the difference was statistically significant(P<0.05).There was no significant difference in HR,RR and MAP between the 2 groups at each time point(P>0.05).The SpO_(2)levels of the observation group at T1,T2 and T3 were higher than those of the control group,and the differences were statistically significant(P<0.05).There was no significant difference in PaO_(2)and pH values at T0,T2 and T4 between the 2 groups(P>0.05).The PaCO_(2)level in the observation group was higher than that in the control group at T2,and the difference was statisticall

关 键 词：经内镜逆行性胰胆管造影 老年人 低氧血症 湿化高流量鼻导管通气 

分 类 号：R459.6[医药卫生—治疗学]