经鼻高流量氧疗与面罩吸氧治疗对高原地区患者气管插管全身麻醉期间低氧血症的效果分析  

Analysis of the effect of high-flow nasal cannula oxygen therapy and mask oxygen inhalation therapy on hypoxemia during tracheal intubation general anesthesia in patients at high altitude

作　　者：李小娟 汤丽丽 张丹 LI Xiao-juan;TANG Li-li;ZHANG Dan(Department of Anesthesiology,Wuwei People's Hospital,Wuwei Gansu 733100,China)

机构地区：[1]武威市人民医院麻醉科,甘肃武威733100

出　　处：《临床和实验医学杂志》2024年第6期655-659,共5页Journal of Clinical and Experimental Medicine

基　　金：国家自然科学基金项目(编号:81860275);武威市科技计划B类项目(编号:WW23B02SF071)。

摘　　要：目的探讨经鼻高流量氧疗与面罩吸氧治疗对高原地区患者气管插管全身麻醉期间低氧血症的效果。方法前瞻性选取2023年5月至9月武威市人民医院收治的130例高原地区行气管插管全身麻醉的手术患者作为研究对象,按照随机数字表法将其分为观察组与对照组,每组各65例。麻醉诱导前,对照组采取面罩吸氧,观察组采取经鼻高流量氧疗治疗。比较两组患者插管前、拔管后平均动脉压(MAP)、心率水平,舒适状况量表(GCQ)评分、动脉血二氧化碳分压(PaCO_(2))水平、动脉血氧分压(PaO_(2))水平,并比较两组患者不良事件发生率及无创机械通气时间、再次插管率、呼吸频率、乳酸清除率情况。结果拔管后,观察组患者MAP、心率水平分别为(76.82±5.08)mmHg、(83.82±5.08)次/min,均低于对照组[(87.35±7.12)mmHg、(112.35±7.12)次/min],差异均有统计学意义(P<0.05)。拔管后,观察组GCQ评分为(83.65±10.24)分,高于对照组[(70.26±6.37)分],差异有统计学意义(P<0.05)。拔管后,观察组PaO_(2)、PaCO_(2)水平分别为(84.65±3.14)、(45.34±4.67)mmHg,均高于对照组[(71.32±7.16)、(40.62±5.24)mmHg],差异均有统计学意义(P<0.05)。观察组面部损伤、口咽部干燥、腹胀、鼻周皮肤破裂等不良反应总发生率为3.08%,低于对照组(13.85%),差异有统计学意义(P<0.05);两组患者呼吸频率比较,差异无统计学意义(P>0.05),观察组无创机械通气时间、再次插管率分别为(9.57±1.46)h、3.08%,低于对照组[(15.79±2.64)h、12.31%],乳酸清除率为(14.64±3.57)%,高于对照组[(11.25±4.27)%],差异均有统计学意义(P<0.05)。结论经鼻高流量氧疗治疗对高原地区患者气管插管全身麻醉期间低氧血症的应用效果显著,可进一步稳定患者生命体征,提升PaCO_(2)及PaO_(2)水平,且不良反应发生率较低,降低患者再次插管率,减少机械通气时间,提升乳酸清除率,值得临床应用推广。Objective To explore the effects of high-flow nasal cannula oxygen therapy and mask oxygen therapy on hypoxemia during tracheal intubation general anesthesia in patients at high altitude.Methods A total of 130 surgical patients who underwent general anesthesia for endotracheal intubation in high altitude admitted to Wuwei People's Hospital from May to September 2023 were prospectively selected as the study subjects.They were divided into the observation group and the control group according to random number table method,with 65 patients in each group.Before anesthesia induction,the control group received oxygen inhalation through a mask,while the observation group received high-flow nasal cannula oxygen therapy.The expression levels of mean arterial pressure(MAP),heart rate,general comfort questionnaire(GCQ)score,arterial carbon dioxide pressure(PaCO_(2)),arterial oxygen pressure(PaO_(2))before extubation and after extubation between the two groups of patients were compared,and the incidence of adverse events,non-invasive mechanical ventilation time,reintubation rate,respiratory rate,and lactate clearance rate between the two groups of patients were compared.Results After extubation,the levels of MAP and heart rate in the observation group were(76.82±5.08)mmHg,(83.82±5.08)times/min,which were lower than those in the control group[(87.35±7.12)mmHg,(112.35±7.12)times/min],the differences were statistically significant(P<0.05).After extubation,the GCQ score of the observation group was(83.65±10.24)points,which was higher than that of the control group[(70.26±6.37)points],the difference was statistically significant(P<0.05).After extubation,the levels of PaO_(2) and PaCO_(2) in the observation group were(84.65±3.14)and(45.34±4.67)mmHg,respectively,which were higher than those in the control group[(71.32±7.16)and(40.62±5.24)mmHg],and the differences were statistically significant(P<0.05).The incidence of adverse reactions such as facial injury,dry mouth and pharynx,abdominal distension,and skin rupture aroun

关 键 词：全身麻醉 气管内插管法 经鼻高流量氧疗 面罩吸氧 高原地区 低氧血症 

分 类 号：R614[医药卫生—麻醉学]