经鼻高流量湿化氧疗在心脏外科术后行支气管镜检查中的应用

Application of high-flow nasal cannula oxygen therapy for bronchoscopy after cardiac surgery

目的优化心脏外科术后发生肺部并发症患者接受支气管镜检查时的氧疗方案.方法回顾分析2018-2019年在我科接受心脏外科手术后行支气管镜检查的成年患者临床资料.根据氧疗方式不同,分为常规氧疗组(conventional oxygen therapy,COT组)及经鼻高流量氧疗组(high-flow nasal cannula,HFNC组).COT组术中予以经湿化瓶双侧鼻导管吸氧,气体流量6 L/min.HFNC组术中采用费雪派克呼吸湿化氧疗仪(Fisher&Parker AIRVOTM),气体流量60 L/min,加温至37℃,FiO2=0.45.术后全组患者均予以经湿化瓶双侧鼻导管吸氧,气体流量6 L/min.记录全组患者支气管镜检查时间.记录患者接受支气管镜检查前(T0)、检查时(T1)及检查结束后15 min(T2)生命体征及动脉血气分析.记录两组患者术后视觉模拟评分量表(visual analog scale,VAS)评分.结果127例患者入选本次研究,COT组61例,HFNC组66例.支气管镜检查前,两组患者各项参数间差异无统计学意义.两组患者检查后氧合情况(SpO2、PaO2)较检查前均有所改善,且HFNC组患者氧合改善情况显著高于COT组[T1:PaO2:(122.07±7.95)mm Hg比(85.43±11.11)mm Hg,P<0.05;T2:PaO2:(108.15±10.18)mm Hg比(89.73±6.96)mm Hg,P<0.05].对照各时间点生命体征指标情况,HFNC组患者生命体征较COT组波动幅度小、更为平稳.另一方面,HFNC组患者平均检查时间(14.74±1.88)min显著短于COT组(17.21±1.81)min,检查过程中不良事件发生率低于COT组(1/19),术后VAS评分亦显著低于COT组[(2.45±1.35)比(4.72±1.07),P<0.05].结论HFNC的应用可以优化心脏外科术后发生肺部并发症患者接受支气管镜检查的过程,使患者更安全、更平稳、更配合、更快速地完成检查.

Objective To optimize the oxygen therapy for patients with pulmonary complications after cardiac surgery receiving bronchoscopy.Methods The clinical data of 127 adult patients who underwent bronchoscopy after cardiac surgery in Xinhua Hospital from 2018 to 2019 were analyzed retrospectively.Depending on the type of oxygen supplied,all the patients were divided into conventional oxygen therapy group(COT group)and high-flow nasal cannula group(HFNC group).In the COT group.oxygen was given through the nasal catheter on both sides of the humidified bottle and the gas flow was 6 L/min.In the HFNC group,Fisher&Parker A1RVO™was used(The gas flow rate was 60 L/min,heated to 37°C and FiO2=0.45).After the examination,all the patients were given oxygen via bilateral nasal catheters with a humidified bottle and the gas flow rate was 6 L/min.All the bronchoscopy time of the whole patients were recorded.All the patient's vital signs and arterial blood gas analysis before the bronchoscopy(T0),during of the examination(T1)and 15 minutes after the examination(T2)were recorded.The postoperative visual analog scale(VAS)scores of all the patients were also recorded.Results 127 patients were enrolled in this study,including 61 cases in the COT group and 66 cases in the HFNC group.Before bronchoscopy,there was no statistical difference between the two groups.The oxygenation status(SpO2,PaO2)of the two groups was improved compared with that before the examination and the improvement of oxygenation of the HFNC group was significantly higher than that of the COT group[T1:PaO2:(122.07±7.95)mm Hg vs.(85.43±11.11)mm Hg,P<0.05;T2:PaO2:(108.15±10.18)mm Hg vs.(89.73±6.96)mm Hg,P<0.05].The vital signs of the HFNC group were more stable than those of the COT group.On the other hand,the average examination time of the patients in the HFNC group was significantly shorter than that in the COT group[(14.74±1.88)min vs.(17.21±1.81)min].The incidence of adverse events during the examination was lower than that of the COT group(1/19).The post-VAS score was also significantly lower than that of the COT group[(2.45±1.35)vs.(4.72±1.07),P<0.05].Conclusion The application of HFNC can optimize the process of undergoing bronchoscopy in patients with pulmonary complications after cardiac surgery,which makes patients safer,smoother,more cooperative and faster.