摘要
目的探讨经鼻高流量氧疗(HFNC)在患儿斜视矫正术中唤醒的应用价值。方法择期行斜视矫正术患儿45例,男21例,女24例,年龄7~12岁,ASAⅠ级,BMI 18~25 kg/m^(2),生长发育良好。随机分为三组:HFNC组(H组)、鼻导管组(N组)和喉罩组(L组),每组15例。H组通过经鼻高流量氧疗吸入氧气2 L·kg^(-1)·min^(-1),最高至70 L/min,FiO_(2)50%,温度34℃。N组经鼻导管吸氧1 L·kg^(-1)·min^(-1),最高至6 L/min,FiO_(2)(21+流量×4)%。L组置入相应型号的喉罩后,经麻醉机予以空氧混合气体3 L/min,FiO_(2)60%,维持吸入2%七氟醚。所有患儿均保留自主呼吸。术中使用BIS监测麻醉深度。分别记录入室时、手术开始时、唤醒前、唤醒成功和手术结束时的HR、MAP、SpO_(2)、RR和BIS。记录丙泊酚和瑞芬太尼用量、唤醒时间和术后苏醒时间。记录低氧血症、呼吸抑制、心动过速、体动反应、呼吸支持等发生情况。结果手术开始时H组和L组HR明显慢于N组(P<0.05),SpO_(2)、RR明显高于N组(P<0.05),H组SpO_(2)明显低于L组(P<0.05)。手术开始时H组和L组MAP、RR、BIS差异无统计学意义。L组唤醒时间和苏醒时间明显长于N组和H组(P<0.05)。三组丙泊酚、瑞芬太尼用量差异无统计学意义。H组和L组呼吸支持发生率明显低于N组(P<0.05),低氧血症、呼吸抑制、心动过速等不良反应发生率低于N组,差异无统计学意义。三组无一例发生体动不良反应。结论与使用鼻导管或喉罩的患儿比较,HFNC应用于患儿斜视矫正术中唤醒,能够减少呼吸支持,保障患儿呼吸道安全,患儿的唤醒时间和苏醒时间短,适合临床推广。
Objective To investigate the application value of high-flow nasal cannula(HFNC)oxygen therapy in intraoperative awakeing of strabismus correction in children.Methods Forty-five children,21 males and 24 females,aged 7-12 years,BMI 18-25 kg/m^(2),ASA physical statusⅠ,and good growth and development,were randomly divided into three group:HFNC group(group H),nasal catheter group(group N)and laryngeal mask group(group L),15 children in each group.Oxygen 2 L·kg^(-1)·min^(-1) was inhaled in group H through high-flow nasal cannula oxygen therapy,with the maximum flow up to 70 L/min,FiO_(2)50%,and at 34℃.Group N was given oxygen 1 L·kg^(-1)·min^(-1),up to 6 L/min,FiO_(2)(21+flow×4)%.Group L was implanted with the corresponding type of laryngeal mask,and the mixture of air and oxygen was given 3 L/min,FiO_(2)60%,and 2%sevoflurane was inhaled through the anesthesia machine.Spontaneous breathing was retained in all patients.BIS was used to monitor anesthetic depth during the operation.HR,MAP,SpO_(2),RR and BIS were recorded at the time of entry,at the beginning of operation,before awakening,when awakening and at the end of operation.The dosage of propofol and remifentanil,awakening time and postoperative awakening time were recorded in the three groups.The occurrence of hypoxemia,respiratory depression,tachycardia,body movement and respiratory support were recorded.Results At the beginning of operation,HR in groups H and L was significantly slower than that in group N,SpO_(2) and RR were significantly higher than those in group N(P<0.05),the SpO_(2) in group H was significantly lower than that of group L(P<0.05).There was no significant difference in MAP,RR and BIS between groups H and L at the beginning of surgery.The intraoperative awakening time in group L was significantly longer than that of groups N and H(P<0.05).There was no significant difference in the dosage of propofol and remifentanil among the three groups.The incidence of respiratory support in groups H and L was significantly lower than that in group N(P<0.05),and the incidence of adverse reactions such as hypoxemia,respiratory depression and tachycardia was lower than that in group N,with no statistical significance.There was no body-movement adverse reaction in the three groups.Conclusion Compared with the use of nasal catheter or laryngeal mask in children with strabismus correction,HFNC can reduce respiratory support and ensure the safety of children s respiratory tract,and the intraoperative awakening time and postoperative waking time of children are shorter,which is suitable for clinical promotion.
作者
丁素娟
鞠学军
杨庆松
徐亚杰
姜蕾
王健
DING Sujuan;JU Xuejun;YANG Qingsong;XU Yajie;JIANG Lei;WANG Jian(Department of Anesthesiology,Affiliated Hospital&Nanjing Tongren Hospital,Medical College of Southeast University,Nanjing 211102,China)
出处
《临床麻醉学杂志》
CAS
CSCD
北大核心
2022年第3期270-274,共5页
Journal of Clinical Anesthesiology
关键词
经鼻高流量氧疗
斜视矫正术
术中唤醒
小儿麻醉
气道管理
High-flow nasal cannula oxygen therapy
Correction of strabismus
Intraoperative wake-up
Pediatric anesthesia
Airway management
