兩種氧流量HFNC對高齡患者ERCP術中呼吸功能的影響  

Effect of two oxygen flow rates on respiratory function in elderly patients undergoing ERCP via HFNC

作　　者：錢曉暉 冼東鋒 李濤 CHIN Hiufai;XIAN Dong-feng;LI Tao(Department of Anesthesiology,Kiang Wu Hospital,Macao,China)

机构地区：[1]澳門鏡湖醫院麻醉科,中國澳門

出　　处：《镜湖医学》2024年第2期36-38,86,共4页MEDICAL JOURNAL OF KIANG WU

摘　　要：目的比較兩種氧流量的高流量氧氣鼻導管通氣(HFNC)對靜脈麻醉下行内視鏡下逆行胰膽管造影術(ERCP)的高齡患者呼吸功能的影響。方法擬行2021年1月~2022年3月ERCP高齡患者,隨機分為兩組:低流量組(n=28)患者行氧流量20L/minHFNC;高流量組(n=30)病人行氧流量40L/minHFNC。兩組患者均使用丙泊酚靶控輸注複合芬太尼靜脈麻醉。記錄患者術前及麻醉誘導後45min的靜脈氧分壓(PvO_(2))、靜脈二氧化碳分壓(PvCO_(2))、pH值,比較同一時間點組間差異及不同時間點組内差異,並比較兩組患者SpO_(2)低於95%、需要氣道干預及患者體動致手術中斷的發生率。結果58例同一時間點兩組間PvO_(2)、PvCO_(2)、pH值比較未見統計學差異。不同時間點組内比較,低流量組患者麻醉誘導後45min的PvO_(2)、PvCO_(2)及pH值與術前比較無統計學差異;高流量組患者麻醉誘導後45min的PvO_(2)、PvCO_(2)較術前顯著升高,pH值較術前顯著降低(P<0.05)。兩組患者丙泊酚用藥量無統計學差異。兩組患者手術過程中SpO_(2)低於95%、需要氣道干預及患者體動致手術中斷的發生率無統計學差異。結論20L/minHFNC用於靜脈麻醉下行ERCP的高齡患者45min内能保證患者足夠氧供,同時不引起二氧化碳蓄積。Objective To compare the effects of two different oxygen flow rates on respiratory function in elderly patients undergoing endoscopic retrograde cholangiopancreatography(ERCP)under intravenous anesthesia via high-flow nasal cannula(HFNC).Methods Elderly patients were randomly divided from January 2021 to March 2022 into two groups:the low-flow group(n=28)underwent an oxygen flow 20L/min HFNC,patients in the high-flow group(n=30)underwent an oxygen flow of 40 L/min HFNC.Intravenous anesthesia with propofol targeted controlled infusion combined with fentanyl were administered in patients in both groups.The partial pressure of venous oxygen(PvO_(2)),partial pressure of venous carbon dioxide(PvCO_(2))and pH of patients before operation and 45 min after anesthesia induction were documented.Differences between groups at the same time point and intra-group differences at different time points were compared.The incidence of SpO_(2) less than 95%,requiring airway intervention and surgical interruption caused by body movement were compared between the two groups.Results A total 58 cases There was no significant difference in PvO_(2),PvCO_(2) and pH between the two groups at the same time point.Intra-group differences at different time points were compared,there was no significant difference between the PvO_(2),PvCO_(2) and pH of patients in the low-flow group 45 minutes after anesthesia induction compared with those before surgery.The PvO_(2)and PvCO_(2)values in the high-flow group 45 minutes after anesthesia induction were significantly higher than those before surgery,and the pH value was significantly lower than that before operation(P<0.05).There was no significant difference in propofol dosage between the two groups.There was no significant difference between the two groups in terms of the incidence of SpO_(2) lower than 95%,need for airway intervention,or interruption of surgery due to patient movement.Conclusion HFNC therapy at a rate of 20L/min can ensure adequate oxygen supply within 45 minutes for elderly patien

关 键 词：内鏡下逆行胰膽管造影 經鼻導管濕化高流量通氣 全靜脈麻醉 高齡 

分 类 号：R61[医药卫生—外科学]