经鼻高流量氧疗在新生儿全身麻醉气管插管中的应用

Application of nasal humidification high-flow oxygen therapy in endotracheal intubation under neonatal general anesthesia

目的新生儿因自身耐缺氧能力差而易在全身麻醉诱导期出现低氧血症。经鼻高流量氧疗可延长呼吸暂停期间的耐缺氧程度。本研究探讨经鼻高流量氧疗用于新生儿全身麻醉诱导后气管插管操作过程的安全性及可行性。方法选取2023年5—11月在郑州大学第三附属医院接受气管插管全身麻醉择期手术治疗的新生儿60例。采用随机数字表法,将患儿分为经鼻高流量氧疗组(H组)和常规氧疗组(C组),每组各30例。两组患儿常规行静脉诱导。主要结局指标为插管期间最低血氧饱和度(pulse oxygen saturation,SpO_(2))、最低SpO_(2)出现的时间及SpO_(2)开始下降的时间;次要结局指标为插管期间最高及最低心率(heart rate,HR)、最低HR出现的时间及HR开始下降的时间、心动过缓发生率(HR<100次/min),记录两组首次插管成功率、插管时间、SpO_(2)<90%发生率。结果共60例新生儿纳入本研究,男性32例,女性28例,出生天数为0~28 d。H组插管期间最低SpO_(2)高于C组(97%vs 95%,P<0.05)、SpO_(2)开始下降的时间长于C组(36.6 s vs 17 s,P<0.05)、最低HR高于C组(138.0 vs 129.5,P<0.05)、HR开始下降的时间长于C组(13 s vs 11 s,P<0.05)。两组最低SpO_(2)出现时间、最高HR、最低HR出现的时间、心动过缓发生率比较差异无统计学意义(P>0.05)。两组首次插管成功率、插管时间、低氧血症发生率差异也均无统计学意义(P>0.05)。结论经鼻高流量氧疗的应用可延长患儿全身麻醉诱导期气管插管过程中SpO_(2)和HR开始下降的时间,提高最低SpO_(2)和最低心率,在新生儿使用安全、可行。

Objective Neonates are prone to hypoxemia during the induction period of general anesthesia due to their poor ability to tolerate hypoxia.Nasal high-flow oxygen therapy prolongs tolerance to hypoxia during apnea.This study investigated the safety and feasibility of nasal high-flow oxygen therapy for endotracheal intubation after neonatal general anesthesia induction.Methods A total of 60 neonates who underwent elective surgery under general anesthesia for endotracheal intubation in the Third Affiliated Hospital of Zhengzhou University from May to November 2023 were enrolled.The children were divided into nasal high-flow oxygen therapy group(group H)and conventional oxygen therapy group(group C)by random number table method,with 30 cases in each group.Intravenous induction was routinely performed in both groups.The primary outcome measures were minimum pulse oxygen saturation(SpO_(2)),time to minimum SpO_(2) onset,and time to onset of SpO_(2) decline during intubation.Secondary outcome measures were the highest and lowest heart rate(HR),the time to the occurrence of the lowest HR and the time to HR onset decline,and the incidence of bradycardia(HR<100 beats/min),and the success rate of the first intubation,the time of intubation,and the incidence of SpO_(2)<90%were recorded in the two groups.Results A total of 60 neonates were included in this study,including 32 males and 28 females,with a range of birth days from 0 to 28 d.The lowest SpO_(2) during intubation in group H was higher than that in group C(97%vs 95%,P<0.05),the time for SpO_(2) to decline was longer than that in group C(36.6 s vs 17s,P<0.05),the lowest HR was higher than that in group C(138.0 vs 129.5,P<0.05),and the HR began to decline longer than that in group C(13s vs 11s,P<0.05).There were no significant differences in the occurrence time of the lowest SpO_(2),the highest HR,the lowest HR occurrence and the incidence of bradycardia between the two groups(P>0.05).There were no significant differences in the success rate of the first intubation,the time of intubation,and the incidence of hypoxemia between the two groups(P>0.05).Conclusion The application of nasal high-flow oxygen therapy can prolong the time for SpO_(2) and HR to begin to decline during endotracheal intubation during general anesthesia induction,and increase the minimum SpO_(2) and minimum heart rate,which is safe and feasible for use in neonates.