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-东南大学学报医学版

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

单位：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

分类号：R614.2

出版年·卷·期（页码）：2024·43·第五期（684-690）

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(PaO₂)、动脉血二氧化碳分压(PaCO₂)、脉搏氧饱和度(SpO₂)、心率(HR)、平均动脉压(MAP)、插管时间、窒息安全时间、SpO₂<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SpO₂、PaO₂升高(P<0.05),插管前3组SpO₂、PaO₂ 升高(P<0.05);与插管前比较,插管成功后 M、H组SpO₂、PaO₂下降(P<0.05),PaCO₂升高(P<0.05),H+N组PaO₂、PaCO₂下降(P<0.05)。插管成功后,与M组相比,H+N组 SpO₂、PaO₂ 升高(P<0.05),PaCO₂降低(P<0.05);与H 组相比,H+N组PaO₂ 升高(P<0.05),PaCO₂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 SpO₂<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(PaO₂), arterial carbon dioxide partial pressure(PaCO₂), pulse oxygen saturation(SpO₂), 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 SpO₂_<sub> <95% were recorded. Besides, the incidence of postoperative adverse events were also recorded. Results: Compared with preoxygenation, SpO₂ and PaO₂ of the three groups were increased after 5 min of preoxygenation(P<0.05), SpO₂ and PaO₂ were increased in the three groups before intubation(P<0.05). Compared with before intubation, SpO₂ and PaO₂ in group M and H were decreased(P<0.05) and PaCO₂ was increased(P<0.05) at after intubation, PaO₂ and PaCO₂ were decreased in group H+N(P<0.05). Compared with group M, SpO₂ and PaO₂ in group H+N were increased(P<0.05), PaCO₂ 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 SpO₂<95% in group M was higher than that in group H and H+N during intubation(P<0.05). There was no significant differences in adverse events among the three groups. Conclusion: HFNCI provides effective preoxygenation and longer safety time of asphyxia without increasing related complication compared with face mask ventilation during video intubationscope-guided nasotracheal intubation in obese patients.

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