超重及肥胖患者行无痛支气管镜检查时最佳氧流量的研究

Optimal oxygen flow in sedated bronchoscopy for overweight and obese patients

目的 探讨经鼻高流量氧疗(HFNC)应用于超重及肥胖患者行无痛支气管镜检查时的最佳氧流量。方法 收集2022年4至9月在浙江省肿瘤医院行无痛支气管镜检查且BMI≥25 kg/m~2的患者60例,收集患者的一般资料及既往病史,评估患者是否存在打鼾,并收集STOP-Bang问卷评分。按随机数字表法分为组1(氧流量10 L/min)、组2(氧流量20 L/min)、组3(氧流量30 L/min)、组4(氧流量40 L/min)、组5(氧流量50 L/min)、组6(氧流量60 L/min),每组各10例。各组患者连接HFNC,给予舒芬太尼镇痛及丙泊酚镇静,并设置不同的氧流量(10~60 L/min),观察支气管镜检查过程中低氧血症发生率以及需要的气道干预措施。结果随着氧流量增加,超重及肥胖患者的低氧血症发生率显著下降,分别为60.0%、40.0%、30.0%、30.0%、10.0%、0(P<0.01)。干预措施即托下颌及增加氧流量比例均明显下降(均P<0.01),需要面罩加压给氧的患者比例差异无统计学意义(P>0.05)。使用Probit回归分析后,最低90%有效氧流量(EF_(90))为49.9 L/min,95%CI为38.9~86.2 L/min;最低95%有效氧流量(EF_(95))为59.2 L/min,95%CI为45.6~109.8 L/min。结论 随着氧流量增加,超重及肥胖患者的低氧血症发生率明显下降,需要的气道干预措施(托下颌、增加氧流量)减少。对于超重及肥胖患者,建议直接给予50 L/min以上的氧流量进行气道管理。

Objective To determine the optimal oxygen flow of the high flow nasal cannula(HFNC)in sedated bronchoscopy for overweight and obese patients.Methods Sixty patients with BMI≥25 kg/m^(2) who underwent sedated bronchoscopy in Zhejiang Cancer Hospital from April to September 2022 were enrolled.Demographic information and past medical history(including snoring history)of the patients were collected,and the STOP-Bang questionnaire was also completed.Patients were randomly divided into six groups with 10 cases in each group,and different oxygen flow(10,20,30,40,50,60 L/min)was given during sedated bronchoscopy.Sufentanil and propofol were administered to maintain sedation,the incidence of hypoxemia and the need for airway intervention during bronchoscopy was recorded.Results With the increase of oxygen flow,the incidence of hypoxemia decreased from 60.0%to 40.0%,30.0%,30.0%,10.0%and 0 in 6 groups(P<0.01),respectively.The incidence of jaw thrust maneuvers and requirement for increased oxygen flow decreased significantly with increasing oxygen flow rates(both P<0.01),while the incidence of bag-mask ventilation had no significant difference(P>0.05).Probit regression showed that the effective flow(EF90)was 49.9 L/min(95%CI:38.9-86.2 L/min)and EF95 was 59.2 L/min(95%CI:45.6-109.8 L/min).Conclusion With the increase of oxygen flow,the incidence of hypoxemia and the need for airway intervention in overweight and obese patients undergoing sedated bronchoscopy is decreased significantly,and an oxygen flow rate more than 50 L/min is suggested for the airway management.