连续气道正压通气和高流量湿化氧疗方式下患者行纤维支气管镜诊疗的临床观察

Clinical observation of fiberoptic bronchoscopy in patients undergoing continuous positive airway pressure and high-flow humidification cannula oxygen therapy

目的探讨连续气道正压通气(CPAP)和高流量湿化氧疗(HFHCO)方式下患者行纤维支气管镜操作的临床效果。方法选择2018年12月至2019年7月使用纤维支气管镜诊疗的26例留置人工气道患者,根据患者行纤维支气管镜的操作次数,将其分为CPAP组(32例次)和HFHCO组(32例次)。比较两组患者在纤维支气管镜诊疗操作前及诊疗操作过程中心率、呼吸频率、平均动脉压、外周动脉血氧饱和度(SaO2)以及操作前后患者血液pH值、动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)、脉搏血氧饱和度(SpO2)。记录两组患者在行纤维支气管镜诊疗中的不良反应发生情况。结果操作中,HFHCO组患者心率[(121±3)次/min vs.(130±3)次/min]、呼吸频率[(21.3±2.7)次/min vs.(26.1±2.3)次/min]及平均动脉压[(99±7)mmHg vs.(109±8)mmHg]均较CPAP组患者显著降低(t=5.232、5.164、6.424,P均<0.001)。操作后,CPAP组和HFHCO组患者pH值[(7.45±0.05)vs.(7.45±0.07)]、PaO2[(86.5±7.3)mmHg vs.(88.3±6.7)mmHg]、PaCO2[(40.1±7.5)mmHg vs.(39.4±6.8)mmHg]及SpO2[(93.9±2.4)%vs.(94.1±2.0)%]水平比较,差异均无统计学意义(t=0.222、0.468、0.420、0.348,P=0.731、0.670、0.684、0.697)。与同组操作前比较,CPAP组和HFHCO组患者操作中心率[(86±4)次/min vs.(130±3)次/min,(87±4)次/min vs.(121±3)次/min,t=9.826、9.612,P均<0.001]、呼吸频率[(17.8±2.5)次/min vs.(26.1±2.3)次/min,(16.7±2.9)次/min vs.(21.3±2.7)次/min,t=8.488、5.837,P均<0.001]及平均动脉压[(78±7)mmHg vs.(109±8)mmHg,(77±7)mmHg vs.(99±7)mmHg,t=9.104、8.224,P均<0.001]及操作后PaO2[(67.8±2.6)mmHg vs.(86.5±7.3)mmHg,(68.9±4.0)mmHg vs.(88.3±6.7)mmHg,t=7.126、6.395,P均<0.001]水平均显著升高。两组患者在进行纤维支气管镜诊疗操作过程中均未发生严重出血、恶性心律失常、气胸等事件。结论对于留置气管插管或气管切开留置套管的患者,在应用CPAP或HFHCO给氧方式下行纤维支气管镜操作时均可改善患者气道通气,提高患者PaO2,但是HFHCO给氧方式下患者的舒适度更好,减轻了患者呼吸、血流动力学体征的明显波动。

Objective To investigate the clinical effect of fiberoptic bronchoscopy in patients undergoing continuous positive airway pressure(CPAP)and high-flow humidification cannula oxygen therapy(HFHCO).Methods Twenty-six patients with indwelling artificial airway who were treated by fiberoptic bronchoscopy from December 2018 to July 2019 were enrolled.According to the operation times of fiberoptic bronchoscopy,they were divided into a CPAP group(32 times)and a HFHCO group(32 times).The heart rate,respiratory rate,mean arterial pressure,and peripheral arterial blood saturation(SaO2)before and during fiberoptic bronchoscopy and pH value,arterial partial pressure of oxygen(PaO2),arterial partial pressure of carbon dioxide(PaCO2),and pulse oxygen saturation(SpO2)before and after operation were compared between the two groups.The adverse effects of fiberoptic bronchoscopy were recorded in both groups.Results During operation,the heart rate[(121±3)beats/min vs.(130±3)beats/min],respiratory rate[(21.3±2.7)breaths/min vs.(26.1±2.3)breaths/min],and mean arterial pressure[(99±7)mmHg vs.(109±8)mmHg]in the HFHCO group were significantly lower than those in the CPAP group(t=5.232,5.164,6.424;all P<0.001).After operation,the pH value[(7.45±0.05)vs.(7.45±0.07)],PaO2[(86.5±7.3)mmHg vs.(88.3±6.7)mmHg],PaCO2[(40.1±7.5)mmHg vs.(39.4±6.8)mmHg],and SpO2[(93.9±2.4)%vs.(94.1±2.0)%]of the the CPAP group and HFHCO group showed no significant difference(t=0.222,0.468,0.420,0.348;P=0.731,0.670,0.684,0.697).Compared with the same group before operation,the heart rate[(86±4)beats/min vs.(130±3)beats/min,(87±4)beats/min vs.(121±3)beats/min;t=9.826,9.612;both P<0.001],respiratory rate[(17.8±2.5)breaths/min vs.(26.1±2.3)breaths/min,(16.7±2.9)breath/min vs.(21.3±2.7)breaths/min;t=8.488,5.837;both P<0.001],and mean arterial pressure[(78±7)mmHg vs.(109±8)mmHg,(77±7)mmHg vs.(99±7)mmHg;t=9.104,8.224;both P<0.001]during operation and PaO2[(67.8±2.6)mmHg vs.(86.5±7.3)mmHg,(68.9±4.0)mmHg vs.(88.3±6.7)mmHg;t=7.126,6.395;both P<0.001]after operation all significantly elevated in the CPAP group and HFHCO group.No serious bleeding,malignant arrhythmia,or pneumothorax occurred during the course of fiberoptic bronchoscopy in the two groups.Conclusions For patients with indwelling tracheal intubation or tracheotomy cannula,CPAP or HFHCO can improve their airway ventilation and PaO2 during bronchofibroscope procedures.However,patients with HFHCO are more comfortable and HFHCO can avoid significant fluctuations in their respiratory and hemodynamic signs.