不同模式经鼻高流量吸氧预防肥胖患者非气管插管全麻期间低氧血症的效果  

Efficacy of different modes of high-flow nasal cannula oxygen in preventing hypoxemia during general anesthesia in obese patients without intubation

作　　者：王亮 刘晓宇 沈文瑞 尹宁 Wang Liang;Liu Xiaoyu;Shen Wenrui;Yin Ning(Department of Anesthesiology,Sir Run Run Hospital,Nanjing Medical University,Nanjing 211100,China)

机构地区：[1]南京医科大学附属逸夫医院麻醉科,南京211100

出　　处：《中华麻醉学杂志》2023年第12期1490-1494,共5页Chinese Journal of Anesthesiology

基　　金：南京医科大学科技发展基金一般项目(NMUB2019088)。

摘　　要：目的评价不同模式经鼻高流量吸氧(HFNC)预防肥胖患者非气管插管期间低氧血症的效果。方法选择行非插管全麻手术患者84例,性别不限,年龄18~64岁,ASA分级I或Ⅱ级,BMI≥30 kg/m^(2),采用随机数字表法分为3组(n=28):鼻导管吸氧组(NC组)、经鼻高流量全程吸非纯氧组(HFNC1组)和经鼻高流量半程吸非纯氧组(NHFC2组)。NC组经双侧鼻导管吸氧,氧流量5 L/min,麻醉诱导后氧流量不变;NHFC1组行HFNC,流量30 L/min、FiO_(2)41%,麻醉诱导后调整氧流量至60 L/min,FiO_(2)不变;NHFC2组行HFNC,流量30 L/min、FiO_(2)100%,麻醉诱导后调整氧流量至60 L/min,FiO_(2)41%。预吸氧3 min后静脉注射舒芬太尼0.1μg/kg,开环模式TCI丙泊酚效应室靶浓度4μg/ml;BIS值至60时开启闭环模式TCI丙泊酚,效应室靶浓度不变,术中BIS值维持45~60。记录麻醉期间低氧血症(SpO_(2)<92%)发生情况和总持续时间、麻醉期间SpO_(2)最低值;分别于麻醉诱导前、预吸氧3 min和麻醉后10 min时行动脉血气分析,记录PaO_(2)和PaCO_(2);记录呼吸道干预情况和不良事件发生情况。结果NC组有1例患者因麻醉方式改变而排除。与NC组比较,HFNC2组低氧血症发生率降低,低氧血症总持续时间缩短,SpO_(2)最低值升高,呼吸道干预手段使用率降低,预吸氧3 min和麻醉后10 min时PaO_(2)升高,PaCO_(2)降低(P<0.05),HFNC1组预吸氧3 min时PaCO_(2)降低,麻醉后10 min时PaO_(2)升高,PaCO_(2)降低(P<0.05),其余指标差异无统计学意义(P>0.05);与HFNC1组比较,HFNC2组低氧血症发生率降低,低氧血症总持续时间缩短,SpO_(2)最低值更高、呼吸道干预手段使用率降低,预吸氧3 min时PaO_(2)升高(P<0.05);3组间不良事件发生率比较差异无统计学意义(P>0.05)。结论采用预吸氧时FiO_(2)100%、麻醉维持时FiO_(2)41%的模式行HFNC可减少肥胖患者非气管插管全麻期间低氧血症的发生。Objective To assess the efficacy of different modes of high-flow nasal cannula(HFNC)oxygen therapy modes in preventing hypoxaemia during general anesthesia in obese patients without endotracheal intubation.Methods Eighty-four American Society of Anesthesiologists Physical Status classificationⅠorⅡpatients of either sex,aged 18-64 yr,with body mass index≥30 kg/m^(2),undergoing non-intubated general anesthesia surgery,were divided into 3 groups(n=28 each)by a random number table method:nasal cannula oxygen therapy group(NC group),HFNC oxygen therapy full-course non-pure oxygen group(HFNC1 group)and HFNC oxygen therapy half-course non-pure oxygen group(NHFC2 group).NC group received oxygen through bilateral nasal cannula,and the oxygen flow rate was 5 L/min,and the oxygen flow rate remained unchanged after anesthesia induction.In NHFC1 group,the flow rate was 30 L/min and the FiO_(2) was 41%,and the flow rate was adjusted to 60 L/min after anesthesia induction,and the FiO_(2) remained unchanged.NHFC2 group received HFNC oxygen inhalation with a flow rate of 30 L/min and FiO_(2)100%,and the flow rate was adjusted to 60 L/min and FiO_(2)41%after anesthesia induction.Sufentanil 0.1μg/kg was intravenously injected after 3 min of oxygen pre-inhalation and target effect-site concentration of propofol was 4μg/ml in open-loop TCI mode,the closed-loop mode was used to continue intravenous infusion of propofol when the BIS value reached 60 with the same target effect-site concentration,and the intraoperative BIS value was maintained at 45-60.The occurrence and total duration of hypoxemia(SpO_(2)<92%)and the lowest value of SpO_(2) during anesthesia were recorded.Arterial blood gas analysis was performed before anesthesia induction,at 3 min of oxygen pre-inhalation and at 10 min after anesthesia,and PaO_(2) and PaCO_(2) were recorded.Respiratory interventions and adverse events were recorded.Results One patient was excluded due to change of anesthesion method in NC group.Compared with NC group,the incidence of hypoxemi

关 键 词：氧吸入疗法 肥胖症 无创通气 低氧血症 

分 类 号：R614[医药卫生—麻醉学]