序贯HFNC对中老年患者全麻胆囊切除术后低氧血症与再插管率的影响

Effect of sequential HFNC on postoperative hypoxemia and re-intubation rate in elderly patients undergoing cholecystectomy under general anesthesia

目的探讨拔除气管插管后序贯经鼻高流量氧疗(HFNC)对中老年患者全麻胆囊切除术后低氧血症和再插管率的影响。方法采用前瞻性随机对照研究,选取2019年1月至12月新疆维吾尔自治区第三人民医院重症医学科收治的全麻下行胆囊切除术患者90例,将其随机分为HFNC组(30例)、鼻导管组(30例)、面罩组(30例)。比较拔除气管插管前后各组间心率(HR)、血压和血气分析指标[动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))、氧合指数],以及拔管后患者不适感和再插管率情况。结果拔除气管插管前,3组患者间HR、收缩压(SBP)、PaO_(2)、PaCO_(2)、氧合指数比较,差异无统计学意义(P>0.05)。拔管后1 h,3组患者间HR和SBP比较,差异无统计学意义(P>0.05);HFNC组患者的PaO_(2)与氧合指数均高于面罩组,PaCO_(2)低于面罩组,差异均有统计学意义(P=0.013,P=0.009,P=0.031),但与鼻导管组比较,差异均无统计学意义(P=0.106,P=0.101,P=0.545);面罩组与鼻导管组相比,PaO_(2)和氧合指数差异均无统计学意义(P=0.363,P=0.314)。鼻导管组黏膜干燥抱怨所占比例最高,面罩组的幽闭恐惧和恶心呕吐所占比例最高,差异均有统计学意义(P<0.05)。3组患者再插管率比较,差异无统计学意义(P=0.484)。结论对于中老年全麻下行胆囊切除术后低氧血症的患者而言,相比面罩氧疗,拔除气管插管后采用序贯HFNC可以更好地改善患者的PaO_(2)、PaCO_(2)、氧合指数和不适感,但不能降低再插管率。

Objective To verify the effect of sequential HFNC after extubation of tracheal intubation on postoperative hypoxemia and re-intubation rate in elderly patients after cholecystectom under general anesthesia.Methods In a prospective randomized controlled trial,90 patients who underwent cholecystectomy under general anesthesia in the Department of Critical Care of the Third People's Hospital of Xinjiang Uygur Autonomous Region from January to December 2019 were randomly divided into HFNC group(n=30),nasal catheterization group(n=30)and mask group(n=30).Blood pressure,HR,and blood gas analysis indicators(PaO_(2),PaCO_(2),oxygenation index)before and after extubation were compared,as well as patient comfort level and reintubation rate after extubation.Results Before tracheal extubation,there were no differences in HR,SBP,PaO_(2),PaCO_(2),and oxygenation index between the three groups(P>0.05).One hour after extubation,there was no difference in HR and SBP among the three groups(P>0.05).PaO_(2)(P=0.013)and oxygenation index(P=0.009)in HFNC group were higher than those in mask group,PaCO_(2)in HFNC group was lower than that in mask group(P=0.031),but there was no difference between HFNC group and nasal catheterization group(P=0.106,P=0.101,P=0.545).The complaints of mucous membrane dryness was the highest in the nasal catheterization group while claustrophobia,nausea and vomiting were the highest in the mask group(P<0.05).Compared with the re-intubation rate,there was no difference between three groups(P=0.484).Conclusion For elderly patients with hypoxemia after cholecystectomy under general anesthesia,sequential HFNC after tracheal extubation can better improve PaO_(2),PaCO_(2),oxygenation index,and discomfort,but cannot reduce the rate of re-intubation.