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.
Application of high flow nasal cannular insufflation on video intubationscope-guided nasotracheal intubation in obese patients
Objective:To evaluate the effect of high flow nasal cannular insufflation(HFNCI)on video intubation-scope-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 intu-bation 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 comple-ted.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(TO),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＜95％were recorded.Besides,the inci-dence 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 de-creased 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 statisti-cally 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.
high flow nasal cannular insufflationobesityvideo intubationscopenasotracheal intubationpreox-ygenation
万方数据
维普
