湿化高流量鼻导管通气在睡眠呼吸暂停低通气综合征患儿全麻拔管后的应用

Application of high-flow nasal cannula oxygen therapy in postoperative surgical OSAHS children

目的探索湿化高流量鼻导管通气(HFNC)应用于睡眠呼吸暂停低通气综合征(OSAHS)患儿射频温控消融术后拔管的安全性及有效性。方法选取气管插管全身麻醉下择期行射频温控消融术的OSAHS患儿50例(ASAⅠ~Ⅱ级),根据拔出气管导管后不同吸氧方法,将患儿随机分为两组。M组(对照组,n=25)采取普通面罩吸氧,初始流量5 L/min,FiO_(2)=41%,10 min后根据患儿SpO_(2)调节吸入氧流量直至停止,维持SpO_(2)在96%以上。H组(观察组,n=25)采取HFNC(广州鲸科医疗科技有限公司,型号HF807C),连接适合患儿的双腔鼻导管进行氧疗。具体设定方法为:起始FiO_(2)为60%~80%,氧气流量2 L/(kg·min),最大氧流量12~18 L/min,湿度100%,温度37℃。10 min后根据患儿SpO_(2)水平调整FiO_(2)及氧流量,维持SpO_(2)在96%以上,当FiO_(2)降到0.3时,尝试停用HFNC。观察患儿进入麻醉恢复室(PACU)留观拔管后各时点心率(HR)、平均动脉压(MAP)、脉搏血氧饱和度(SpO_(2))、呼吸频率(RR),记录两组患儿PACU时舒适度、耐受程度及低氧血症、二次气管插管等不良反应发生率等。结果H组患儿拔管后氧疗时间长于M组,H组复苏时间及低氧血症发生率少于M组,但组间比较差异无统计学意义(P>0.05);拔管后5 min,M组的HR和RR稍低于H组,拔管后10 min,M组SpO_(2)稍高于H组,差异有统计学意义(P<0.05),但均在正常范围内,无实际临床意义。两组患儿其他各时点的SpO_(2)、RR、HR比较,差异均无统计学意义(P>0.05)。结论HFNC应用于全麻拔管后OSAHS患儿是安全有效的,可作为其全麻拔管后的一种给氧方式在临床应用。

Objective To assess the safety and effects of high-flow nasal cannula oxygen therapy in postoperative surgical children.Methods A total of 50 children of obstructive sleep apnea hypopnea syndrome(OSAHS)under the general anaesthesia with endotracheal intubation in our hospital were randomly divided into observation group(group H,n=25)and control group(group M,n=25).The children in the group M were treated with mask oxygen,and the children in the group H were treated with HFNC.The differences of the SPO_(2),breathing rate,heart rate,comfortable,tolerance and hypoxemia,reintubation rate of the two groups were observed and compared.Results The heart rate and breathing rate score of group M at T2 were slightly lower than that of group H,and the difference was statistically significant(P<0.05).SpO_(2) of group M was slightly higher than that of group H at T3(P<0.05),but both of them were within the normal range and had no clinical significance.The differences of SpO_(2),breathing rate,heart rate at other points were not statistically significant between the two groups(P>0.05).The differences in the duration of oxygen therapy,the lowest SpO_(2) level and the rates of hypoxemia after extubation were not statistically significant(P>0.05)between the two groups.Conclusion HFNC is feasible,effective and safe for the OSAHS children after extubation.