摘要
目的评价经鼻咽导管窒息氧合技术对重度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者全麻诱导气管插管时无通气安全时间的影响。方法择期行全麻腭咽成形术的重度OSAHS患者80例,男62例,女18例,年龄18~56岁,BMI 30~42 kg/m^2,ASAⅠ或Ⅱ级,改良Mallampati分级Ⅰ-Ⅲ级。采用随机数字法分为两组:经鼻咽导管窒息氧合组(N组)和对照组(C组),每组40例。两组均采用相同的全凭静脉诱导方案,诱导后模拟长时间气管插管。N组意识消失后置入鼻咽导管,确认可以面罩通气,给予肌松药待肌松效果满意后置入喉镜暴露声门结构,并在此时开始经鼻咽导管给予15 L/min湿化纯氧。C组常规麻醉诱导,肌松效果满意后置入喉镜暴露声门结构。记录两组停止面罩通气时的呼气末氧浓度(C ET O 2)、面罩通气停止后SpO 2达到的最低值、插管后开始通气时的P ET CO 2。记录患者无通气安全时间(停止面罩通气至患者SpO 2降至95%的时间),插管后开始通气至SpO 2恢复至100%时间。记录术后24 h鼻腔出血、牙齿损伤、咽喉痛、声音嘶哑、口咽出血等气管插管相关并发症的发生情况。结果与C组比较,N组面罩通气停止后SpO 2达到的最低值明显升高(P<0.05),插管后开始通气时的P ET CO 2明显升高(P<0.05),无通气安全时间明显延长(P<0.05),插管后开始通气至SpO 2回复至100%的时间明显缩短(P<0.05)。两组面罩通气停止时的C ET O 2差异无统计学意义。两组鼻腔出血、牙齿损伤、咽喉痛、声音嘶哑、口咽出血等气管插管相关并发症差异无统计学意义。结论经鼻咽导管窒息氧合技术安全、简便,可以延长重度OSAHS患者全麻诱导气管插管时无通气安全时间,提高其全麻诱导的安全性。
Objective To evaluate the effect of nasal cannula apneic oxygenation technique on duration of non-hypoxic apnea during tracheal intubation after inducting general anesthesia among severe obstructive sleep apnea hypopnea syndrome(OSAHS)patients.Methods Eighty patients with OSAHS,62 males and 18 females,aged 18-56 years,BMI 30-42 kg/m^2,falling into ASA physical statusⅠorⅡ,Mallampati gradeⅠ-Ⅲ,were scheduled for elective uvulopalatopharyngoplasty,were divided into 2 groups(n=40)by random number table method:nasal cannula apneic oxygenation group(group N)and control group(group C).A simulated prolonged intubation was performed to determine the duration of non-hypoxic apnea after all patients underwent standard intravenous induction.After patients lost consciousness in group N,nasopharyngeal catheters were placed to confirm mask ventilation,muscle relaxants were given,and laryngoscope was placed to expose glottis structure after satisfactory muscle relaxations.Meantime 15 L/min humidified pure oxygen were given through nasopharyngeal catheters.Patients in group C were induced routine anesthesia,then laryngoscope was inserted to expose glottis structure after satisfactory muscle relaxations.Value of C ET O 2 when mask ventilation was stopped,minimum value of SpO 2 after stopping mask ventilation,and value of P ET CO 2 when ventilation began after intubation were recorded.Duration of non-hypoxic apnea safety time,the time from intubation to SpO 2 value reached 100%were recorded as well.The incidence of tracheal intubation related complications such as nasal bleeding,tooth injury,sore throat,hoarseness and oropharyngeal bleeding were recorded at 24 h after operation.Results Compared with group C,there was no significant difference in the value of C ET O 2 when mask ventilation was stopped in group N.And the minimum value of SpO 2 after stopping mask ventilation was significantly increased(P<0.05),P ET CO 2 value when ventilation began after intubation increased significantly(P<0.05),the duration of non-hypoxic apnea safety time was prolonged(P<0.05),and the time from intubation to SpO 2 value reached 100%was shorter in group N(P<0.05).There was no statistically significant difference between two groups of complications related to tracheal intubation,such as nasal bleeding,tooth injury,sore throat,hoarseness,and oropharyngeal bleeding.Conclusion In severe OSAHS patients,nasal cannula apneic oxygenation technique can significantly increase the safe apneic duration during induction of anesthesia.
作者
张杨
马浩南
于泳浩
ZHANG Yang;MA Haonan;YU Yonghao(Department of Anesthesiology,Tianjin Medical University General Hospital Tianjin Research Institute of Anesthesiology,Tianjin 300052,China)
出处
《临床麻醉学杂志》
CAS
CSCD
北大核心
2020年第11期1096-1099,共4页
Journal of Clinical Anesthesiology
