高流量鼻氧管复合鼻咽通气道在肥胖患者不插管全麻中对通气情况的改善效果  

Clinical observation on the improvement of ventilation in obese patients under general anesthesia without intubation using high flow nasal oxygen tube combined with nasopharyngeal airway

作　　者：滕琦[1] 梁然[1] 王睿 刘萍 闫昱霖 Teng Qi;Liang Ran;Wang Rui;Liu Ping;Yan Yulin(Department of Anesthesiology,Lianyungang Hospital of Traditional Chinese Medicine,Lianyungang 222000,China)

机构地区：[1]连云港市中医院麻醉科,连云港222000

出　　处：《中国医师杂志》2024年第8期1174-1179,共6页Journal of Chinese Physician

基　　金：江苏省自然科学基金青年基金(BK20201015)。

摘　　要：目的观察高流量鼻氧管复合鼻咽通气道对不插管全麻肥胖患者通气情况改善的效果。方法前瞻性选取2023年1月至10月连云港市中医院收治的不插管全麻肥胖患者86例,采用随机数字表法分为对照组和观察组,每组各43例。观察组给予高流量鼻氧管复合鼻咽通气道通气,对照组给予普通鼻氧管复合仰头举颌法通气。比较两组围手术期呼吸功能、血气指标、血流动力学、脉搏血氧饱和度(SpO_(2))及并发症情况。结果两组组内不同氧流量2 L/min、4 L/min、6 L/min时的呼吸末二氧化碳分压(PetCO_(2))、氧合指数(OI)比较,差异有统计学意义(F=7.548,P=0.001;F=7.658,P=0.002),观察组4 L/min、6 L/min时的PetCO_(2)、OI高于对照组,差异有统计学意义(均P<0.05)。两组组内麻醉前(T_(0))、麻醉10 min(T_(1))、术毕时(T_(2))时间点的氧分压(PaO_(2))、二氧化碳分压(PaCO_(2))比较,差异有统计学意义(F=10.024,P<0.001;F=10.236,P<0.001),观察组T_(1)、T_(2)时点的PaO_(2)高于对照组,PaCO_(2)低于对照组,差异有统计学意义(均P<0.001)。两组组内T_(0)、T_(1)、T_(2)时间点的平均动脉压、心率比较,差异有统计学意义(F=8.476,P<0.001;F=8.321,P<0.001),观察组T_(1)、T_(2)时间点的平均动脉压、心率低于对照组,差异有统计学意义(均P<0.001)。两组组内T_(0)、T_(1)、T_(2)时间点的SpO_(2)比较,差异有统计学意义(F=7.548,P<0.001),观察组T_(1)、T_(2)时间点的SpO_(2)高于对照组,差异有统计学意义(均P<0.001)。观察组总并发症发生率低于对照组(P<0.05)。结论高流量鼻氧管复合鼻咽通气道用于肥胖患者不插管全麻中可明显改善其围手术期呼吸功能、血气指标及SpO_(2),稳定血流动力学,降低并发症发生风险。ObjectiveTo observe the effect of high flow nasal cannula combined with nasopharyngeal airway on improving ventilation in obese patients under general anesthesia without intubation.MethodsA total of 86 obese patients under general anesthesia without intubation admitted to the Lianyungang Hospital of Traditional Chinese Medicine from January to October 2023 were prospectively selected and randomly divided into a control group and an observation group using a random number table method,with 43 cases in each group.The observation group was given high flow nasal cannula combined with nasopharyngeal airway ventilation,while the control group was given ordinary nasal cannula combined with head lifting ventilation.Two groups were compared in terms of perioperative respiratory function,blood gas indicators,hemodynamics,pulse oximetry(SpO_(2)),and complications.ResultsThere was a statistically significant difference(F=7.548,P=0.001;F=7.658,P=0.002)in the final respiratory carbon dioxide pressure(PetCO_(2))and oxygenation index(OI)between the two groups with different oxygen flow rates of 2 L/min,4 L/min,and 6 L/min.The PetCO_(2)and OI in the observation group were higher than those in the control group at 4 L/min and 6 L/min,and the difference was statistically significant(all P<0.05).There was a statistically significant difference(F=10.024,P<0.001;F=10.236,P<0.001)in the oxygen partial pressure(PaO_(2))and carbon dioxide partial pressure(PaCO_(2))before anesthesia(T_(0)),10 minutes after anesthesia(T_(1)),and at the end of surgery(T_(2))between the two groups.The PaO_(2)in the observation group was higher than that in the control group at T_(1)and T_(2),while the PaCO_(2)was lower than that in the control group,and the difference was statistically significant(all P<0.001).The difference in mean arterial pressure and heart rate at T_(0),T_(1),and T_(2)time points between the two groups was statistically significant(F=8.476,P<0.001;F=8.321,P<0.001).The average arterial pressure and heart rate at time points T_(1)and T_(2)

关 键 词：高流量鼻氧管 鼻咽通气道 肥胖 不插管全麻 通气 

分 类 号：R614[医药卫生—麻醉学]