摘要
目的探讨拟行髋关节置换术的强直性脊柱炎患者全麻诱导气管插管期间使用湿化高流量鼻导管通气提高氧合的疗效分析。方法采用前瞻性、开放、单臂研究设计,选择28例行髋关节置换术的强直性脊柱炎患者,静脉注射丙泊酚、瑞芬太尼全身麻醉后,使用视可尼或纤维支气管镜行气管插管操作,并全程佩戴湿化高流量鼻导管通气装置进行氧合支持,记录患者张口距离、甲颏距离、颈项活动度、改良Mallampati分级、上唇咬合分级、插管期间低血氧饱和度(SpO_(2)<90%为低氧血症,90%≤SpO_(2)<95%为失饱和状态)发生率、SpO_(2)最低值、气管插管时间、呼气末二氧化碳最高值和气管插管相关并发症等。结果28例强直性脊柱炎患者平均张口距离(3.3±1.0)cm,颈项活动度中位值2.5°(0°,20°),1例(3.6%)患者SpO_(2)<90%,6例(21.4%)患者SpO_(2)<95%,插管成功前最低SpO_(2)平均值(97.1±2.9)%,插管时间(10.9±4.3)min,呼气末二氧化碳分压最高值(50.9±6.3)mmHg,未见气管插管相关并发症,患者满意度VAS评分(9.1±0.8)分。结论湿化高流量鼻导管通气辅助强直性脊柱炎患者全麻气管插管,有助于减少长时间气管插管操作所致的低氧血症发生,提高患者麻醉满意度,为保障手术麻醉安全提供有力支持。
Objective This study explored the effect of humidified high flow nasal cannula(HFNC)to improve oxygenation during general anesthesia induction in patients with ankylosing spondylitis who were to undergo hip replacement.Methods The study adopts a prospective,open,single-arm research design.The study selected 28 patients with ankylosing spondylitis who underwent hip arthroplasty and received intravenous injection of propofol and remifentanil for general anesthesia.Anesthesiologists use video laryngoscopy or fiberoptic bronchoscope to perform tracheal intubation,and use HFNC for oxygenation support throughout the process.The researchers recorded the patient′s mouth opening distance,thyroid chin distance,neck mobility,modified Mallampati classification,upper lip bite test classification,incidence of hypoxemia(SpO_(2)<90%and 95%)during intubation,minimum SpO_(2),trachea Intubation time,the highest value of PetCO_(2),and complications related to tracheal intubation.Results The average opening distance of 28 patients with ankylosing spondylitis is(3.3±1.0)cm,the median neck mobility is 2.5°(0°,20°),1 patient(3.6%)SpO_(2)<90%,6 patients(21.4%)SpO_(2)<95%,the lowest average value of SpO_(2) before successful intubation is(97.1±2.9)%,the average time of intubation is(10.9±4.3)min,and the highest end-tidal carbon dioxide value is(50.9±6.3)mmHg.There were no complications related to tracheal intubation,and the patient satisfaction VAS score is(9.1±0.8).Conclusion HFNC assists general anesthesia for tracheal intubation in patients with ankylosing spondylitis,which helps reduce the occurrence of hypoxemia caused by prolonged tracheal intubation operations,improves patient satisfaction with anesthesia,and provides a powerful way to ensure the safety of anesthesia support.
作者
罗南博
刘志恒
李智
张杰
李俊杰
余庆敏
郑欣洵
LUO Nan-bo;LIU Zhi-heng;LI Zhi;ZHANG Jie;LI Jun-jie;YU Qing-min;ZHENG Xin-xun(Department of Anesthesiology,Shenzhen Second Hosipital,Shenzhen 518035,Guangdong,China;不详)
出处
《广东医学》
CAS
2021年第9期1073-1078,共6页
Guangdong Medical Journal
基金
深圳市医疗卫生“三名工程”项目(SZSM201612026)。
关键词
强直性脊柱炎
气管插管
湿化高流量鼻导管通气
ankylosing spondylitis
tracheal intubation
humidified high flow nasal cannula
