经鼻高流量湿化氧疗用于老年患者经食管超声无痛检查术的优化效果  

Efficacy of high-flow nasal cannula oxygen therapy in optimizing painless transesophageal echocardiography in elderly patients

作　　者：费青 崔丽婷 胡益民 肖悦 曹雅男 王春梅 Fei Qing;Cui Liting;Hu Yimin;Xiao Yue;Cao Yanan;Wang Chunmei(Department of Anesthesiology,The Affiliated Changzhou No.2 People′s Hospital of Nanjing Medical University,Changzhou 213000,China)

机构地区：[1]南京医科大学附属常州第二人民医院麻醉科,常州213000

出　　处：《中华麻醉学杂志》2023年第12期1503-1506,共4页Chinese Journal of Anesthesiology

摘　　要：目的评价经鼻高流量湿化氧疗(HFNC)用于老年患者经食管超声无痛检查术的优化效果。方法拟行经食管超声检查术老年患者60例,性别不限,年龄60~75岁,ASA分级Ⅱ级,BMI 18.5~23.9 kg/m^(2),采用随机数字表法分为2组(n=30),HFNC组:采用HFNC装置,吸纯氧10 L/min预氧合3 min;常规通气组(C组):经鼻导管吸纯氧6 L/min预氧合3 min;依次静脉注射舒芬太尼0.1μg/kg、瑞马唑仑0.25~0.30 mg/kg;HFNC组氧气流速滴定到60 L/min(37℃,FiO_(2)100%);而C组维持氧气流速6 L/min(FiO_(2)100%)。患者取平卧左倾位,待睫毛反射消失后进行经食管超声检查术,操作刺激诱发呛咳、体动时,间断静脉注射瑞马唑仑0.1 mg/kg。观察检查术中缺氧事件、托下颌干预和通气相关不良事件的发生情况;记录检查术时间、麻醉苏醒时间和瑞马唑仑用量。结果与C组比较,HFNC组严重缺氧发生率和托下颌干预率明显降低(7%/0和53%/17%,P<0.05),术中最低SpO_(2)明显升高(P<0.05),检查术时间、瑞马唑仑用量和麻醉苏醒时间差异无统计学意义(P>0.05)。两组均未见与通气相关不良事件的发生。结论HFNC可明显优化老年患者经食管超声无痛检查术的通气管理。Objective To evaluate the efficacy of high-flow nasal cannula(HFNC)oxygen therapy in optimizing painless transesophageal echocardiography in elderly patients.Methods Sixty American Society of Anesthesiologists Physical Status classificationⅡpatients,regardless of gender,aged 60-75 yr,with body mass index of 18.5-23.9 kg/m^(2),were randomized into 2 groups(n=30 each)by a random number table method:group HFNC and conventional ventilation group(group C).Pure oxygen 10 L/min was inhaled for 3 min preoxygenation using the HFNC device in group HFNC.Group C inhaled pure oxygen at 6 L/min for 3 min preoxygenation via a nasal cannula.Sufentanil 0.1μg/kg and remazolam 0.25-0.30 mg/kg were intravenously injected in turn.Group HFNC was connected to a high-flow humidification oxygen therapy device and inhaled pure oxygen at 60 L/min(37℃,FiO_(2)100%).The flow rate of pure oxygen was maintained at 6 L/min(FiO_(2)100%)in group C.The patients were placed in left lateral decubitus position,esophageal ultrasound was performed after the eyelash reflex disappeared,and remazolam 0.1 mg/kg was intravenously injected intermittently when bucking and body movement were induced by operation stimulation.The occurrence of hypoxia-related adverse events,mandibular intervention and ventilation-related adverse events was observed during examination.The operation time,time of emergence from anesthesia and consumption of remazolam were recorded.Results Compared with group C,the incidence of severe hypoxia and rate of mandibular intervention were significantly decreased(7%/0 and 53%/17%,P<0.05),the lowest intraoperative SpO_(2) was increased(P<0.05),and no significant change was found in the operation time,time of emergence from anesthesia and consumption of remazolam in group HFNC(P>0.05).No ventilation-related adverse events occurred in both groups.Conclusions HFNC can markedly optimize the ventilation management of elderly patients undergoing painless transesophageal echocardiography.

关 键 词：氧吸入疗法 连续气道正压通气 气道管理 超声心动描记术 经食管 

分 类 号：R614[医药卫生—麻醉学]