摘要
目的比较湿化高流量鼻导管通气(HFNC)与传统鼻导管吸氧模式对丙泊酚靶控输注(TCI)复合芬太尼全凭静脉麻醉下高龄患者经内镜胰胆管造影(ERCP)手术期间氧供的影响。方法57例诊断为胆总管结石、年龄>80岁的高龄患者,随机分为两组。H组(n=29)患者给予HFNC,C组(n=28)为传统鼻导管。比较两组患者在丙泊酚TCI复合芬太尼麻醉下ERCP手术过程中,SpO_(2)<95%发生率、动脉氧分压(PaO_(2))、动脉二氧化碳分压(PaCO_(2))、酸碱度(pH),以及需要气道干预或患者体动造成手术中断的发生率。结果H组与C组相比PaO_(2)、PaCO_(2)有显著升高(P<0.05),pH值则低于C组(P<0.05)。两组在手术时长、麻醉时长方面无明显差异,但H组丙泊酚用药量明显大于C组(P<0.05)。ERCP手术过程中SpO_(2)<95%的发生率,以及因为气道维护、患者体动导致的手术操作中断发生率,H组明显低于C组(P<0.05)。结论高龄患者在丙泊酚TCI复合芬太尼全凭静脉麻醉下接受ERCP手术期间使用HFNC可以提供更好的气道管理,减少低氧血症和手术中断的概率,但需要加强长时间手术患者术中的动脉血气监测。
Objective To investigate the clinical practice of humidified high flow nasal cannula(HFNC)in the target-controlled infusion(TCI)of propofol plus fentanyl for ERCP in the elderly patients.Methods A total of 57 elderly patients(ASAII~III,age>80 years)with common bile duct stones were randomly divided into HFNC group(H group,n=29)and control group(C group,n=28).The H group and the C group was accepted oxygen supply with HFNC and traditional nasal catheter respectively.All the patients accepted ERCP operations in prone position.Both groups were given TCI propofol and fentanyl 0.5~1μg/kg iv.For each patient,the arterial blood gas including PaO_(2),PaCO_(2) and pH were tested immediately after the surgery.The incidence of SpO_(2)<95%,airway interventions,body movements during the procedures,and the operation duration,anesthesia time and the consumption of propofol were all recorded.Results Compared with the group C,the PaO_(2) and PaCO_(2) were significantly higher in the group H(P<0.05),while the PH value in the group H was lower(P<0.05).The operation duration and anesthesia time showed no difference between the two groups,but the propofol consumption was more in group H(P<0.05).The incidence of SpO_(2)<95%and the surgical interruption due to the body movements in the C group were significantly higher than those in H group(P<0.05).Conclusion For the elderly patients under propofol TCI general anesthesia,the use of humidified high flow nasal cannula can achieve better oxygenation and airway management with low incidence of hypoxemia and surgical interruption during ERCP procedure,while arterial blood gas should be monitored for long time procedure.
作者
陈超
许学兵
顾盼
谷寅
CHEN Chao;XU Xue-bing;GU Pan;GU Yin(Department of.4nesthesiology,the HonKong Unirersity-Shenzhen Hospital,Shenzhen 518053,Guangdong,China)
出处
《广东医学》
CAS
2021年第9期1044-1047,共4页
Guangdong Medical Journal
关键词
经内镜逆行胰胆管造影
湿化高流量鼻导管通气
全静脉麻醉
老年
endoscopic retrograde cholangiopancreatography
high flow nasal cannula oxygen therapy
total intravenous anesthesia
elderly
