经鼻高流量吸氧在肥胖患者经鼻可视软镜气管插管中的应用  

Application of high flow nasal cannular insufflation on video intubationscope-guided nasotracheal intubation in obese patients

作　　者：叶奎 耿鹏程 陈霞 李仁虎 胡悦 郑立东 YE Kui;GENG Pengcheng;CHEN Xia;LI Renhu;HU Yue;ZHENG Lidong(Department of Anesthesiology,2.Department of Pharmacy,Lu'an Hospital Affiliated to Anhui Medical University,Lu'an 237000,China)

机构地区：[1]安徽医科大学附属六安医院麻醉科,安徽六安237000 [2]安徽医科大学附属六安医院药学部,安徽六安237000

出　　处：《东南大学学报（医学版）》2024年第5期684-690,共7页Journal of Southeast University(Medical Science Edition)

基　　金：安徽省科技局项目(AHWJ2023A30202);六安市人民医院科研课题面上项目(2021kykt05)。

摘　　要：目的:探究经鼻高流量吸氧(HFNCI)在肥胖患者经鼻可视软镜气管插管中的应用效果。方法:选择择期行全身麻醉下胃肠手术的肥胖患者(BMI≥28 kg·m^(-2))75例,随机分为面罩组(M组)、HFNCI组(H组)和HFNCI复合鼻咽通气道组(H+N组),每组25例。M组予以面罩预充氧,H组和H+N组均采用HFNCI设备预充氧,待麻醉诱导完成后,所有患者均行可视软镜经鼻气管插管,记录患者在预充氧前(T0)、预充氧5 min后(T1)、经鼻插管前(T2)和插管成功后(T3)4个时间点动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))、脉搏氧饱和度(SpO_(2))、心率(HR)、平均动脉压(MAP)、插管时间、窒息安全时间、SpO_(2)<95%的比例以及相关并发症发生率。结果:与预充氧前比较,预充氧5 min后3组SpO_(2)、PaO_(2)升高(P<0.05),插管前3组SpO_(2)、PaO_(2)升高(P<0.05);与插管前比较,插管成功后M、H组SpO_(2)、PaO_(2)下降(P<0.05),PaCO_(2)升高(P<0.05),H+N组PaO_(2)、PaCO_(2)下降(P<0.05)。插管成功后,与M组相比,H+N组SpO_(2)、PaO_(2)升高(P<0.05),PaCO_(2)降低(P<0.05);与H组相比,H+N组PaO_(2)升高(P<0.05),PaCO_(2)明显下降(P<0.05)。3组插管时间差异无统计学意义(P>0.05);与M组相比,H组和H+N组窒息安全时间明显延长(P<0.05),而H组和H+N组无差异(P>0.05);插管期间M组SpO_(2)<95%发生率明显高于H+N组(P<0.05);3组不良事件发生率差异无统计学意义(P>0.05)。结论:经鼻高流量吸氧在肥胖患者经鼻可视软镜气管插管中,预充氧效果及窒息安全时间均优于传统面罩通气,且未增加相关并发症发生率。Objective:To evaluate the effect of high flow nasal cannular insufflation(HFNCI)on video intubationscope-guided nasotracheal intubation in obese patients.Methods:Seventy-five obese patients(BMI≥28 kg·m^(-2))undergoing gastrointestinal surgery under general anesthesia were randomized into 3 groups(n=25)to receive facemask preoxygenation followed by face mask ventilation(Group M),oxygenation with HFNCI(Group H),or preoxygenation with HFNCI combined with nasopharyngeal airway(Group H+N).In group M,nasotracheal intubation was achieved after preoxygenation and mechanical ventilation through mask.While in the group H and H+N,high-flow oxygen inhalation through the nasal catheter was performed until nasotracheal intubation was completed.For all the patients,the arterial oxygen partial pressure(PaO_(2)),arterial carbon dioxide partial pressure(PaCO_(2)),pulse oxygen saturation(SpO_(2)),heart rate(HR),and mean arterial pressure(MAP),were recorded before preoxygenation(T0),at 5 min of preoxygenation(T1),before intubation(T2)and after intubation(T3).The intubation time,safety time of asphyxia,and the incidence rate of SpO_(2)<95%were recorded.Besides,the incidence of postoperative adverse events were also recorded.Results:Compared with preoxygenation,SpO_(2)and PaO_(2)of the three groups were increased after 5 min of preoxygenation(P<0.05),SpO_(2)and PaO_(2)were increased in the three groups before intubation(P<0.05).Compared with before intubation,SpO_(2)and PaO_(2)in group M and H were decreased(P<0.05)and PaCO_(2)was increased(P<0.05)at after intubation,PaO_(2)and PaCO_(2)were decreased in group H+N(P<0.05).Compared with group M,SpO_(2)and PaO_(2)in group H+N were increased(P<0.05),PaCO_(2)was increased(P<0.05)at after intubation.The intubation time of the three groups was not statistically significant(P>0.05).Compared with group M,group H and H+N were significantly longer(P<0.05)at the safety time of asphyxia.The incidence of SpO_(2)<95%in group M was higher than that in group H and H+N during intubation(P<0.05).Ther

关 键 词：经鼻高流量吸氧 肥胖 可视软镜 经鼻气管插管 预充氧 

分 类 号：R614.2[医药卫生—麻醉学]