经鼻高流量氧疗用于新生儿全麻气管拔管后呼吸支持治疗的效果

Efficacy of high-flow nasal cannula oxygen therapy for respiratory support after tracheal extubation under general anesthesia in neonates

目的评价经鼻高流量氧疗用于新生儿全麻气管拔管后呼吸支持治疗的效果。方法本研究为前瞻性随机对照研究。选择郑州大学第三附属医院2022年12月至2023年11月在全麻气管插管下行普外科手术,并于术后拔除气管导管的新生儿94例,采用随机数字表法分为2组(n=47):常规氧疗组(C组)和经鼻高流量氧疗组(H组)。拔除气管导管后,H组进行经鼻高流量氧疗:氧流量2 L·kg^(-1)·min^(-1),氧气浓度和湿度均为100%,温度37℃;C组行常规面罩通气:氧流量5 L/min,氧气浓度100%,通气频率25~35次/min。于气管拔管后至出手术室前记录指标:主要观察指标为最低SpO_(2)和低氧血症(SpO_(2)<90%)、呛咳、喉痉挛、窒息的发生情况;次要观察指标为呼吸频率(气管拔管即刻、出室即刻)、最低HR和出手术室时间。结果与C组相比,H组最低SpO_(2)升高,低氧血症发生率、出手术室即刻呼吸频率降低(P<0.05),呛咳、喉痉挛、窒息的发生率,以及最低HR、气管拔管即刻呼吸频率和出手术室时间差异无统计学意义(P>0.05)。结论经鼻高流量氧疗用于新生儿全麻气管拔管后呼吸支持,可改善氧合,显著降低低氧血症的发生风险。

Objective:To assess the efficacy of high-flow nasal cannula oxygen therapy for the respiratory support after tracheal extubation under general anesthesia in neonates.Methods:This was a prospective randomized controlled study.Ninety-four neonates undergoing general surgery under general anesthesia with endotracheal intubation and endotracheal tube removal following surgery from December 2022 to November 2023 in the Third Affiliated Hospital of Zhengzhou University were selected and divided into 2 groups(n=47 each)by the random number table method:conventional oxygen therapy group(group C)and high-flow nasal cannula oxygen therapy group(group H).After the endotracheal tube was removed,group H underwent high-flow nasal cannula oxygen therapy:oxygen flow was 2 L·kg^(-1)·min^(-1),the concentration and humidity of oxygen were both 100%,and the temperature was 37℃.Group C underwent conventional mask ventilation with the oxygen flow rate 5 L/min,oxygen concentration 100%,ventilation frequency about 25-35 times/min.The outcome measures were recorded from the time after extubation to the time before discharge from the operating theatre.The main outcome measures were the minimum SpO_(2) and hypoxemia(SpO_(2)<90%),choking,laryngospasm and asphyxia.The secondary outcome measures were respiratory rate(immediate extubation,immediate discharge),minimum HR,and time to discharge from the operating theatre.Results:Compared with group C,the lowest SpO_(2) was significantly increased,the incidence of hypoxemia and respiratory rate immediately after discharge from the operating room was decreased(P<0.05),and no significant changes were found in the incidence of choking,laryngospasm and asphyxia,the lowest heart rate,respiratory rate immediately after tracheal extubation and time to discharge from the operating theatre in group H(P>0.05).Conclusions:High-flow nasal cannula oxygen therapy can improve oxygenation and significantly reduce the risk of hypoxemia when used for the respiratory support after tracheal extubation under general anesthesia in neonates.