经鼻高流量湿化氧疗在宫腔镜手术患者全凭静脉麻醉中的应用

Application of humidified high flow nasal cannula oxygen therapy in total intravenous anesthesia for patients undergoing gynecological hysteroscopy

目的比较经鼻高流量湿化氧疗(HFNC)与传统鼻导管吸氧模式对丙泊酚复合舒芬太尼全凭静脉麻醉下行宫腔镜手术患者手术期间氧合的影响。方法选择择期行宫腔镜手术患者60例,采用随机数字表法将患者分为HFNC组和对照组,每组30例。每组患者均采用丙泊酚复合舒芬太尼全凭静脉不插管麻醉的方法,HFNC组采用经鼻高流量湿化氧疗,对照组采用传统鼻导管吸氧。记录患者的一般情况、手术期间的生命体征、动脉二氧化碳分压(PaCO_(2))、动脉氧分压(PaO_(2))、氧合情况、麻醉药物的使用量、手术时间以及患者的满意度,比较2组患者手术期间SpO_(2)<95%、气道干预和因体动导致手术中断的发生率。结果各组患者的一般情况、手术时间和舒芬用量的比较差异均无统计学意义(P>0.05);与对照组相比,HFNC组丙泊酚用量显著增加[(185.5±30.2)mg vs(208.5±28.7)mg,P<0.05)],手术结束即刻PaO_(2)也显著升高[(171.4±91.3)mmHg vs(304.3±126.4)mmHg,P<0.05)],但PaCO_(2)差异无统计学意义(P>0.05);在手术过程中,SpO_(2)<95%的发生率(26.7%vs 53.5%,P<0.05),手术中断发生率(6.7%vs 43.4%,P<0.05)以及因为气道保护行托下颌(26.7%vs 53.5%,P<0.05)及面罩给氧的发生率(3.3%vs 20%,P<0.05),HFNC组明显低于对照组(P<0.05)。结论在丙泊酚联合舒芬太尼全凭静脉非插管麻醉下行经宫腔镜手术期间,使用HFNC可以为患者提供更好的氧合,降低术中低氧血症的发生率,减少气道干预的次数,为患者带来更好的氧供保证,提高手术麻醉的安全性。

Objective This study aims to investigate the clinical practice of humidified high flow nasal cannula in total intravenous anesthesia with propofol plus sufentanil for patients undergoing gynecological hysteroscopy.Methods A total of 60 female patients(ASAⅠ-Ⅱ,age 18-60 years)undergoing gynecological hysteroscopy were divided into HFNC group(H group,n=30)and control group(C group,n=30)using random number table method.Patients in each group were treated with the same propofol plus sufentanil by intravenous anesthesia.The H group and C group was accepted oxygen supply with HFNC and traditional nasal catheter respectively.The patient’s general condition,vital signs during surgery,the arterial blood gas including PaCO_(2)and PaO_(2)before and after the surgery,oxygenation,anesthetic dosage,operation time,and patient satisfaction were recorded.The incidence of SpO_(2)<95%,airway interventions and body-movements during the procedures were compared between the two groups.Results The general condition,operation duration time and the sufentanil consumption showed on difference between the two groups,but the propofol consumption was more[(185.5±30.2)mg vs 9208.5±28.7)mg,P<0.05)]and the PaO_(2)was higher[(171.4±91.3)mmHg vs(304.3±126.4)mmHg,P<0.05)]after the surgery in group H(P<0.05),but there was no difference in the PaCO_(2)after the surgery between the two groups.During the procedure,the incidence of SpO_(2)<95%(26.7%vs 53.5%,P<0.05,the incidence of surgical interruption(6.7%vs 43.4%,P<0.05),airway interventions(26.7%vs 53.5%,P<0.05)and the surgical interruption(3.3%vs 20%,P<0.05)due to the body-movements in H group were significantly lower than those in C group(P<0.05).Conclusion During the total intravenous anesthesia with propofol plus sufentanil for patients undergoing gynecological hysteroscopy,the application of humidified high flow nasal cannula can achieve better oxygenation and airway management with low incidence of hypoxemia and airway interventions during the procedure,providing a better and safer environment for patients and improving the safety of anesthesia.