预置鼻咽通气管联合头高位预吸氧对行腹腔镜减重手术的病态肥胖症患者肺氧合及血气分析指标的影响

Impact of pre positioned nasopharyngeal airway combined with high head pre inhalation of oxygen on lung oxygenation and blood gas analysis in morbid obesity patients underwent laparoscopic weight loss surgery

目的探讨预置鼻咽通气管联合头高位预吸氧,对行腹腔镜减重手术的病态肥胖症患者肺氧合及血气分析指标的影响。方法选择该院2020年1月-2022年4月收治的拟行择期腹腔镜减重术的病态肥胖症患者100例作为研究对象。按照随机数表法分成A组(头高25°位+预置鼻咽通气管组)和B组(头高25°位+不预置鼻咽通气管组),各50例。两组患者预吸氧3 min后,行静脉麻醉诱导气管插管。观察并记录两组患者入室后呼吸空气(T_(0))、面罩人工正压通气3 min(T_(1))和气管插管后3 min(T_(2))的pH值、动脉血氧分压(PaO_(2))、二氧化碳分压(PCO_(2))、氧合指数(PaO_(2)/FiO_(2))和动脉压-肺泡氧分压比值(a/APO_(2))。记录T_(1)时点、T_(2)时点和气腹后5 min(T_(3))平台压(Pplat)、气道峰压(Ppeak)和动态肺顺应性(Cdyn)。记录气管插管后不同人工通气经皮动脉血氧饱和度(SpO_(2))降至92.0%的时间,以及恢复通气后SpO_(2)恢复到96.0%的时间和不良反应发生情况。结果与B组比较,T_(1)时点,A组PCO_(2)下降,PaO_(2)升高,差异均有统计学意义(P<0.05);与T_(0)时点比较,T_(1)和T_(2)时点,两组患者PaO_(2)/FiO_(2)和PCO_(2)升高,a/APO_(2)下降,差异均有统计学意义(P<0.05)。T_(1)时点,A组Pplat和Ppeak低于B组,Cdyn高于B组,差异均有统计学意义(P<0.05);与T_(1)时点比较,T_(2)和T_(3)时点,A组Pplat和Ppeak升高,Cdyn下降,差异均有统计学意义(P<0.05);与T_(1)时点比较,T_(2)时点,B组Ppeak升高,差异有统计学意义(P<0.05);T_(3)时点,B组Pplat和Ppeak升高,Cdyn下降,差异均有统计学意义(P<0.05)。与B组比较,A组SpO_(2)降至92.0%的时间延长,SpO_(2)恢复到96.0%的时间缩短,差异均有统计学意义(P<0.01)。结论预置鼻咽通气管联合头高位预吸氧,能减少病态肥胖症患者全身麻醉诱导插管中急性呼吸道阻塞的发生,延长无通气时限。

Objective To explore the impact of pre positioned nasopharyngeal airway combined with high head pre inhalation of oxygen on lung oxygenation and blood gas analysis indicators in morbid obese patients undergoing laparoscopic weight loss surgery.Methods 100 morbid obesity patients from January 2020 to April 2022 planned to undergo elective laparoscopic weight loss surgery were selected as the study subjects.All the patients were divided into two groups according to the random number table method:group A with a head height of 25°and a pre installed nasopharyngeal airway;group B with a head height of 25°and no pre installed nasopharyngeal airway,with 50 patients in each group.Two groups were pre oxygenated for 3 min before undergoing intravenous anesthesia to induce tracheal intubation.Observe and record the pH value,partial pressure of oxygen in arterial blood(PaO_(2)),partial pressure of carbon dioxide(PCO_(2)),partial pressure of oxygen in arterial blood/fractional concentration of inspiratory oxygen(PaO_(2)/FiO_(2))as well as the ratio of arterial pressure to alveolar oxygen partial pressure(a/APO_(2))of the two groups of patients who breathed air(T_(0))after entering the room,ventilated with mask positive pressure for 3 min(T_(1)),and intubated with trachea for 3 min(T_(2)).Record plateau pressure(Pplat),peak airway pressure(Ppeak),and dynamic lung compliance(Cdyn)at T_(1),T_(2),and 5 min after pneumoperitoneum(T_(3)).Record the time for percutaneous arterial oxygen saturation(SpO_(2))to decrease to 92.0%under different artificial ventilation after tracheal intubation,the time for SpO_(2) to recover to 96.0%after resumption of ventilation,and the occurrence of adverse reactions.Results Compared with Group B,at time point T_(1),Group A showed a decrease in PCO_(2) and an increase in PaO_(2),with statistically significant differences(all P<0.05);Compared with T_(0),at time points T_(1) and T_(2),PaO_(2)/FiO_(2) and PCO_(2) in the two groups were increased,while a/APO_(2) decreased(all P<0.05).At T_(1) time point,Pplat and Ppeak in Group A were lower than those in Group B,while Cdyn was higher than that in Group B,with statistical significance(P<0.05);Compared with T_(1) time point,at T_(2) and T_(3) time point,Pplat and Ppeak in Group A increased,while Cdyn decreased,with statistically significant differences(all P<0.05);Compared with T_(1),Ppeak increased in B groups at T_(2) time point(P<0.05),while Pplat and Ppeak increased in T_(3) time point,and Cdyn decreased in B group,with statistical significance(all P<0.05).Compared with Group B,Group A had a longer time for SpO_(2) to decrease to 92.0%and a shorter time for SpO_(2) to recover to 96.0%(P<0.01).Conclusion The combination of pre positioned nasopharyngeal airway and high head pre inhalation of oxygen can effectively improve acute respiratory obstruction during induction of general anesthesia insertion in morbid obesity patients,and extend the duration of no ventilation.