经鼻高流量氧疗装置在快速诱导经口气管插管中的应用

Application of high-flow nasal cannula for rapid sequence endotracheal intubation

目的观察经鼻高流量氧疗装置(HFNC)和传统简易呼吸器(AMBU)在快速诱导经口气管插管中的应用效果。方法40例气管插管适应症患者,依据充氧方式的不同分为HFNC组(19例)和AMBU组(21例),HFNC组以HFNC预充氧,ABMU组以ABMU预充氧。两组患者均通过静脉注射丙泊酚实施快速诱导,然后进行经口气管插管。插管过程中,HFNC组继续供氧,ABMU组移除ABMU。记录并比较两组患者快速诱导经口气管插管过程中最低末梢血氧饱和度(Sp O2)、预充氧过程中Sp O2升高值、经口气管插管过程中Sp O2降低值、经口气管插管时间、手法开放通气患者比例。记录并比较两组患者严重低血压事件、呕吐误吸事件、机械通气过程中呼吸机相关性肺炎(VAP)发生例数及28天内死亡例数。结果HFNC组快速诱导经口气管插管过程中最低Sp O2为93%[91%,96%]、经口气管插管过程中Sp O2降低值为3%[2%,7%]、手法开放通气患者比例为15.78%,ABMU组快速诱导经口气管插管过程中最低Sp O2为88%[81%,90%]、经口气管插管过程中Sp O2降低值为10%[8%,12%]、手法开放通气患者比例为66.67%,两组相比,P均<0.05。两组预充氧过程中Sp O2升高值、经口气管插管时间无差异(P均>0.05)。两组严重低血压事件、呕吐误吸事件、机械通气过程中VAP、28天内死亡例数无差异(P均>0.05)。结论与ABMU相比,在快速诱导经口气管插管过程中应用HFNC能更好的维持氧合,减少手法开放通气比例,且不增加不良反应和28天内死亡例数。

Objective To observe the effects of high-flow nasal cannula(HFNC)and airway breathing mask unit(ABMU)in patients during rapid sequence endotracheal intubation in an ICU.Methods According to different measures of oxygenation,40 patients were divided into the HFNC group(19 patients)and AMBU group(21 patients),and all patients were intravenously injected with propofol for rapid sequence induction while being preoxygenated by HFNC or AMBU correspondingly before the intubation.During intubation,the oxygenation by HFNC in the HFNC group lasted till the end of procedure,while AMBU was removed in the AMBU group to ensure the intubation.Afterwards,we recorded and compared the lowest pulse oximetry(Sp O2)throughout the procedure,the increase of Sp O2 during preoxygenation and the decrease of Sp O2 in intubation,intubation time,proportions of mask ventilation,incidences of some related complications such as severe hypotension,vomiting and aspiration,ventilator-associated pneumonia and mortality within 28 days in each group.Results The lowest Sp O2 was 93%[91%,96%],the decrease in Sp O2 during intubation was 3%[2%,7%],and the proportions of mask ventilation was 15.78%in the HFNC group,while the relative results were 88%[81%,90%],10%[8%,12%],and 66.67%in the AMBU group,with statistically significant differences(all P<0.05).Whereas there were no statistical difference in the incidences of severe hypotension,vomiting and aspiration,ventilator-associated pneumonia and mortality within 28 days between these two groups(all P>0.05),as well as the increase in Sp O2 and intubation time(both P>0.05).Conclusion We can maintain higher level of oxygenation by HFNC,with less proportion of mask ventilation and decreased incidences of related complications and mortality within 28 days in comparison with using ABMU.