鼻咽通气管联合无创通气在老年下肢骨科手术中的应用

Application of nasopharyngeal airway combined with noninvasive ventilation in elderly patients undergoing lower limb orthopedic surgery

目的 探讨鼻咽通气管联合无创通气（NIV）在老年下肢骨科手术中的应用价值。方法 将攀钢集团总医院和雅安市中医医院自2014-01—2014-06进行下肢骨科手术的64例老年患者随机分为A、B 2组,2组行椎管内麻醉后均采用相同的设备和方法实施NIV,B组实施NIV前置入6.0-6.5号鼻咽通气管,A组不作特殊处理。比较2组实施NIV前和实施NIV后60 min的动脉血氧饱和度（Sa O2）,动脉血二氧化碳分压（Pa CO2）,气体交换指数（Pa O2/Fi O2）。结果 A组2例、B组1例椎管内麻醉失败改全身麻醉退出研究,最终A组纳入30例,B组纳入31例。A、B组实施NIV前的Sa O2、动脉血Pa CO2和Pa O2/Fi O2比较差异无统计学意义（P〉0.05）,实施NIV 60 min后2组Sa O2、动脉血Pa CO2、Pa O2/Fi O2均较实施NIV前显著改善,差异均有统计学意义（P〈0.05）。B组Pa O2/Fi O2改善更为明显,且与A组比较差异有统计学意义（P〈0.05）;2组Sa O2、动脉血Pa CO2差异无统计学意义（P〉0.05）。结论 在实施NIV的老年骨科手术患者椎管内麻醉后置入鼻咽通气管能有效提高NIV有效性,显著改善患者氧合指标。

Objective To investigate the values of nasopharyngeal airway combined with non-invasive ventilation（NIV） in lower limb orthopedic surgery of elderly patients.Methods From January 2014 to June 2014,64 elderly patients with lower extremity orthopedic surgery in General Hospital of Panzhihua Iron and Steel Group and Traditional Chinese Medical Hospital of Yaan were randomly divided into two groups,A and B.NIV was performed in all patients after intrathecal anesthesia,6.0-6.5 nasopharyngeal airway was placed in group B before NIV while group A simply received NIV.The indicators of blood gas analysis before NIV and 60 min after treatment were recorded and compared.Results Two patients in group A and one patient in group B withdrew from this research because of intrathecal anesthesia failure,30 patients in group A and 31 patients in group B were fit into statistics.Arterial oxygen saturation（Sa O2）,arterial partial pressure of carbon dioxide（Pa CO2）and Pa O2/Fi O2 significantly improved after treatment in all patients（P〈0.05）.Pa O2/Fi O2 were significant improved in group B than those in group A（P〈0.05）,there were no significant differences in Sa O2,Pa CO2 between two groups（P〉0.05）.Conclusion Nasopharyngeal airway can significantly improve the effectiveness of NIV in elderly patients receiving lower extremity orthopedic surgery.