经鼻高流量吸氧对老年经内镜逆行胰胆管造影手术监测麻醉中低氧血症发生率影响  

Endoscopic retrograde cholangiopancreatography in elderly patients undergoing anaesthesia monitored by nasal high flow nasal cannulae effect of incidence of hypoxemia

作　　者：裘治慧 宋丹丹 刁玉刚 陈宁 许兆柱 赵婉彤 QIU Zhi-hui;SONG Dan-dan;DIAO Yu-gang;CHEN Ning;XU Zhao-zhu;ZHAO Wan-tong(Department of Anesthesiology,General Hospital of Northern Theater Command,Shenyang 110016,China)

机构地区：[1]北部战区总医院麻醉科,辽宁沈阳110016

出　　处：《临床军医杂志》2023年第7期683-687,共5页Clinical Journal of Medical Officers

基　　金：辽宁省民生科技计划(2021JH2/10300011)。

摘　　要：目的探讨经鼻高流量吸氧(HFNC)对老年经内镜逆行胰胆管造影(ERCP)手术监测麻醉中低氧血症发生率的影响。方法选取北部战区总医院2021年3—10月收治的104例行ERCP手术的老年患者为研究对象。采用随机数字表法将患者分为A组与B组,每组各52例。两组患者均采用监测麻醉下行ERCP手术。A组患者采用HFNC预吸氧,B组患者采用鼻导管预吸氧。分别于预吸氧前(T_(0))、诱导后(T_(1))、进镜过咽喉(T_(2))、十二指肠乳头插管(T_(3))、退镜(T_(4))、苏醒(T_(5)),记录并比较两组患者脉搏血氧饱和度(SpO_(2))、平均动脉压(MAP)、呼吸频率(RR)、心率(HR)、脑电双频指数(BIS)。分别于T_(0)、T_(2)、T_(5),记录并比较两组患者动脉血二氧化碳分压(PaCO_(2))、动脉血氧分压(PaO_(2))、pH值。记录两组患者总丙泊酚用量、手术时间及苏醒时间、不良反应发生情况。结果两组患者不同时间点MAP、HR、RR比较,差异均无统计学意义(P>0.05)。A组患者T_(2)、T_(3)、T_(4)、T_(5)时的SpO_(2)均高于B组,差异均有统计学意义(P<0.05)。A组患者T_(2)、T_(5)时的PaO_(2)高于B组,T_(5)时的PaCO_(2)低于B组,差异均有统计学意义(P<0.05)。两组患者丙泊酚总用量、手术时间及苏醒时间比较,差异均无统计学意义(P>0.05)。A组患者不良反应发生率为25.00%(13/52),低于B组的61.54%(32/52),差异有统计学意义(P<0.05)。结论HFNC可降低老年患者ERCP手术监测麻醉中低氧血症的发生,不增加术中二氧化碳潴留风险,且安全舒适。Objective To investigate the effect of nasal high flow oxygen inhalation(HFNC)on the incidence of hypoxemia in elderly patients undergoing endoscopic retrograde cholangiopancreatography(ERCP).Methods 104 elderly patients undergoing ERCP sur⁃gery in the General Hospital of Northern Theater Command from March to October 2021 were selected as the study objects.Patients were divided into group A and group B with 52 cases in each group by random number table method.ERCP was performed under moni⁃toring anesthesia in both groups.Patients in group A received HFNC preoxygen,and patients in group B received nasal catheter preoxy⁃gen.Pulse oxygen saturation(SpO_(2)),mean arterial pressure(MAP),respiratory rate(RR),heart rate(HR)and bifrequency index(BIS)of the two groups were recorded and compared before pre⁃oxygenation(T_(0)),after induction(T_(1)),endoscopic transpharynx(T_(2)),duodenal papillary intubation(T_(3)),withdrawal(T_(4))and recovery(T_(5)),respectively.Arterial partial pressure of carbon dioxide(PaCO_(2)),arterial partial pressure of oxygen(PaO_(2))and pH values of the two groups were recorded and compared T_(0),T_(2) and T_(5),re⁃spectively.Total propofol dosage,operation time,recovery time and adverse reactions were recorded in the two groups.Results There was no significant difference in MAP,HR and RR between the two groups at different time points(P>0.05).SpO_(2) levels at T_(2)、T_(3)、T_(4) and T_(5) in group A were higher than those in group B,and the differences were statistically significant(P<0.05).The PaO_(2) at T_(2) and T_(5) in group A was higher than that in group B,and the PaCO_(2) at T_(5) was lower than that in group B,with statistical significance(P<0.05).There were no significant differences in the total dosage of propofol,operation time and recovery time between 2 groups(P>0.05).The incidence of adverse reactions in group A was 25.00%(13/52),lower than that in group B 61.54%(32/52),and the difference was statistically significant(P<0.05).Conclusion HFNC can reduce the incidence

关 键 词：高流量吸氧 经内镜逆行胰胆管造影 低血氧症 监测麻醉 老年 

分 类 号：R657.4[医药卫生—外科学]