文章摘要
湿化高流量鼻导管氧疗在无痛消化内镜诊疗中的应用
The application of humidified high flow nasal cannula in gastrointestinal endoscopy procedures
  
DOI：10.12089/jca.2020.09.012
中文关键词: 湿化高流量鼻导管氧疗  无痛内镜  低氧血症  氧合  丙泊酚
英文关键词: Humidified High Flow Nasal Cannula  Gastrointestinal endoscopy  Hypoxia  Oxygenation  Propofol
基金项目:广东省医学科学技术研究基金（B2018025）；广东省医学科学技术研究基金（B2020016）
作者单位E-mail
康茵 510080,广州市,广东省人民医院,广东省医学科学院麻醉科  
蔡彬 510080,广州市,广东省人民医院,广东省医学科学院麻醉科  
朱毅 510080,广州市,广东省人民医院,广东省医学科学院麻醉科  
崔灿 510080,广州市,广东省人民医院,广东省医学科学院麻醉科  
胡家祺 510080,广州市,广东省人民医院,广东省医学科学院麻醉科  
韦锦锋 510080,广州市,广东省人民医院,广东省医学科学院麻醉科  
毛松松 510080,广州市,广东省人民医院,广东省医学科学院麻醉科  
王春晓 510080,广州市,广东省人民医院,广东省医学科学院麻醉科  
王晟 510080,广州市,广东省人民医院,广东省医学科学院麻醉科（现在林芝市人民医院） shengwang_gz@163.com 
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中文摘要:
      
目的 探讨湿化高流量鼻导管氧疗（HHFNC）用于无痛消化内镜诊疗的临床效果和安全性。
方法 择期行无痛消化内镜诊疗的患者200例，男111例，女89例，年龄18~80岁，BMI 18~30 kg/m2，ASA Ⅰ—Ⅲ级，根据随机数字表将患者分为两组：普通鼻导管氧疗组（C组）和HHFNC组（H组）。C组通过鼻导管吸入氧气5 L/min。H组通过HHFNC系统（PT101AZ）吸入空氧混合气体50 L/min，FiO2 40％。记录术中最低SpO2、经皮二氧化碳分压（PtcCO2）、无创呼吸支持；丙泊酚用量、内镜时间和呼之睁眼时间；低氧血症、高血压、低血压、心动过速、心动过缓、恶心呕吐等不良反应情况。
结果 与C组比较，H组术中最低SpO2明显升高（P<0.05），无创呼吸支持明显减少（P<0.05），低氧血症发生率明显降低（P<0.05），心动过缓发生率明显升高（P<0.05）。两组PtcCO2、丙泊酚用量、内镜时间、呼之睁眼时间、高血压、低血压、心动过速、恶心呕吐差异均无统计学意义。
结论 HHFNC用于无痛消化内镜可改善氧合和降低气道干预需求。
英文摘要:
      
Objective To assess clinical efficacy and safety of humidified high flow nasal cannula (HHFNC) in patients undergoing deep sedation for gastrointestinal endoscopy procedures.
Methods A total of 200 patients scheduled for GI endoscopy under deep sedation with propofol, 111 males and 89 females, aged 18-80 years, BMI 18-30 kg/m2, ASA physical status Ⅰ-Ⅲ, were randomly divided according with random number table to receive oxygen therapy through a nasal cannula (group C) or a HHFNC system (group H). Group C was inhaled 5 L/min of oxygen through nasal cannula, and group H was inhaled 50 L/min of air-oxygen mixed gas through HHFNC system (PT101AZ), and FiO2 was 40%. The lowest SpO2, transcutaneous pressure of carbon dioxide (PtcCO2), patients’ requirement for respiratory support, the amount of propofol, the time of the procedure, the time to open the eyes, incidence of hypoxia， hypertension, hypotension, tachycardia, bradycardia, nausea and vomiting and other adverse events were recorded during the procedures.
Results Comparison with group C, the lowest SpO2 in group H was significantly increased (P < 0.05), the need for noninvasive respiratory support was significantly reduced (P < 0.05), the incidence of hypoxic events was significantly decreased (P < 0.05), and the incidence of transient bradycardia was significantly increased (P < 0.05). There were no differences between the groups in PtcCO2, total propofol dose, procedure time, the time to open the eyes, hypertension, hypotension, tachycardia, post-procedure nausea or vomiting.
Conclusion HHFNC optimized oxygenation and reduced the requirement for airway assist maneuvers in patients undergoing GI endoscopy procedures with deep sedation.
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