经鼻咽通气道高流量氧疗用于肥胖患者无痛支气管镜检查中的疗效与安全性  

作　　者：李杰[1] 刘斌 袁孝忠 刘明娟 邓康 

机构地区：[1]浙江中医药大学研究生院,310053 [2]嘉兴大学附属医院,314001

出　　处：《浙江临床医学》2024年第3期425-427,430,共4页Zhejiang Clinical Medical Journal

基　　金：浙江省教育厅科研项目(Y202249494);浙江省麻醉学区域专病中心(201524);浙江省临床重点专科-麻醉学(2022-01);嘉兴市医学重点学科—麻醉学(2023-ZC-001)。

摘　　要：目的 观察经鼻咽通气道(NPA)高流量氧疗技术用于肥胖患者无痛电子支气管镜检查术(PLEB)中的疗效与安全性。方法 选择2021年6月至2023年5月无痛电子支气管镜检查术患者50例。按随机数字表法分为观察组和对照组各25例。观察组实施经NPA高流量给氧,对照组实施经鼻塞导管高流量给氧。采用全凭静脉麻醉诱导与维持,待患者睫毛反射消失、BIS<60后开始支气管镜操作。记录入室时(T0)、支气管镜检查开始即刻(T1)、支气管镜检查开始后10 min(T2)、支气管镜检查结束即刻(T3)患者PaO_(2)、PaCO_(2)、SpO_(2)、HR、MAP。测量T0和T3时点患者胃窦横截面积。记录不良反应和并发症发生情况。结果 与对照组相比,观察组在T1、T2、T3时点PaO_(2)更高,而PaCO_(2)更低,且观察组在麻醉期间MAP波动更小、低氧血症(SpO_(2)<92%)发生率更低,差异均有统计学意义(P<0.05)。结论 经NPA高流量氧疗技术可为接受PLEB的肥胖患者提供安全有效的通气支持,并显著改善氧合及减少CO_(2)蓄积,值得临床进一步研究与推广。Objective To observe the efficacy and safety of high-flow oxygen through nasopharyngeal airway(NPA)for painless electronic bronchoscopy(PLEB)in obese patients.Methods A total of fifty patients who were scheduled to undergo PLEB in the Affiliated Hospital of Jiaxing University from June 2021 to May 2023 were selected for this study.The patients were randomly divided into two groups(n=25)using the random number table method.The test group received high-flow oxygen through NPA,while the control group received high-flow oxygen through nasal cannula.Total intravenous anesthesia was administered for both the induction and maintenance of anesthesia.PLEB was performed once the patient's bispectral index(BIS)value dropped below 60 and eyelash reflex disappeared.PaO2,PaCO_(2),SpO_(2),heart rate(HR),and mean arterial pressure(MAP)were recorded at the time of admission(T0),immediately after the start of bronchoscopy(T1),10 min after the start of bronchoscopy(T2),and immediately after the end of bronchoscopy(T3).Additionally,the cross-sectional area of the gastric antrum was measured at T0 and T3.The adverse effects and complications were also documented.Results Compared to the control group,the test group exhibited higher PaO_(2) and lower PaCO_(2) levels at T1,T2,and T3.Additionally,the test group experienced less fluctuation in MAP and a lower incidence of hypoxemia(SpO_(2)<92%)during anesthesia.These differences were found to be statistically significant(P<0.05).Conclusion High-flow oxygen through NPA can provide safe and effective ventilation support for obese patients receiving PLEB,and significantly improve oxygenation and reduce CO_(2) accumulation.Further clinical studies and promotion of this technique are warranted.

关 键 词：高流量氧疗 支气管镜检查 肥胖症 鼻咽通气道 

分 类 号：R614[医药卫生—麻醉学]