经鼻湿化快速充气交换通气对肥胖患者麻醉诱导时安全窒息时间的影响

Effect of THRIVE on safe apnea time during anesthesia induction in obese patients

目的探讨基于经鼻湿化快速充气交换通气(THRIVE)的窒息氧合技术在肥胖患者麻醉诱导时对安全窒息时间的影响。方法选择行择期手术的肥胖患者50例,随机分为THRIVE技术(H组)和对照组(C组)。H组用高流量鼻导管预给氧3 min。C组用面罩预给氧3 min。试验的终点为血氧饱和度(SpO_(2))降至95%或呼吸暂停时间达到5 min。记录安全窒息时间,通气初始时刻的呼气末二氧化碳和试验过程中的最低SpO_(2)(从预给氧结束至插管后5 min)和恢复至基线SpO_(2)的时间。结果H组患者的安全窒息时间明显长于C组(t=2.24,P<0.05),最低SpO_(2)明显高于C组(t=2.94,P<0.05)。其中H组有7例,C组有2例,在呼吸暂停时间达到5 min时SpO_(2)未降至95%。两组患者机械通气即刻的ETCO_(2)比较,差异无统计学意义(t=1.79,P>0.05)。与H组比较,C组患者SpO_(2)恢复至基线水平的时间更长(t=4.67,P<0.05)。结论THRIVE技术能够延长肥胖患者的安全窒息时间,增加氧储备,降低气管插管过程中低氧血症的风险。

Objective To explore the effect of transnasal humidified rapid-insufflation ventilatory exchange(THRIVE)on safe apnea time during anesthesia induction.Methods Fifty obese patients who underwent elective surgery were selected and randomly divided into THRIVE group(group H)and control group(group C).The group H was preoxygenated with a high-flow nasal catheter for 3 minutes and the group C was preoxygenated with mask for 3 minutes.The end-point was the time for pulse oxygen saturation(SpO_(2))reduced to 95%or apnea for 5 minutes.Safe apnea time,end-tidal carbon dioxide partial pressure(ETCO_(2))at the beginning of ventilation,minimum SpO_(2)during the test(from the end of preoxygenation to 5 minutes after intubation)and recovery time to baseline SpO_(2)were recorded.Results The safe apnea time in group H was significantly longer than that in group C(t=2.24,P<0.05).The lowest SpO_(2)was significantly higher than that of group C(t=2.94,P<0.05).Among the patients whose SpO_(2)did not drop to 95%when the apnea time reached 5 minutes,there were 7 cases in group H and 2 cases in group C.There was no significant difference in ETCO_(2)between the two groups immediately after mechanical ventilation(t=1.79,P>0.05).Compared with group H,patients in group C had a longer time to recover SpO_(2)to baseline(t=4.67,P<0.05).Conclusion THRIVE prolong the safe apnea time in obese patients,increase oxygen reserve,and reduce the risk of hypoxemia during endotracheal intubation.