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| 不同流量经鼻高流量氧疗在纤维支气管镜检查中的比较 |
| Comparison of different flow rates of high-flow nasal cannula oxygen therapy for fiberoptic bronchoscopy |
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| DOI：10.12089/jca.2024.03.008 |
| 中文关键词: 经鼻高流量氧疗 纤维支气管镜检查 咪达唑仑 阿芬太尼 镇静 低氧血症 |
| 英文关键词: High-flow nasal cannula oxygen therapy Fiberoptic bronchoscopy Midazolam Alfentanil Sedation Hyoxemia |
| 基金项目:宁波市卫生健康科技计划项目（2022Y35） |
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| 摘要点击次数: 216 |
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| 中文摘要: |
目的：评价不同流量经鼻高流量（HFNC）氧疗辅助用于咪达唑仑复合高剂量阿芬太尼深度镇静下纤维支气管镜检查的安全性和有效性。
方法：选择择期镇静麻醉下行纤维支气管镜检查患者160例，男88例，女72例，年龄18～64岁，BMI 15～36 kg/m2，ASAⅠ或Ⅱ级。采用随机数字表法将患者分为四组：对照组（C组，n=38）、HF25组(n=37)、HF45组(n=39)和HF65组(n=37)，C组常规给予鼻导管吸氧5 L/min，HF25组、HF45组和HF65组分别给予25、45、65 L/min流量的HFNC。患者均采用咪达唑仑0.05 mg/kg复合高剂量阿芬太尼（17.5～30.0 μg/kg）镇静麻醉诱导，并在达到目标深度镇静水平后行常规纤维支气管镜检查。记录术中最低SpO2、术中低氧血症发生情况、呛咳VAS评分和呛咳发生情况、乌拉地尔使用情况、术中痛苦回忆和愿意接受再次检查的情况。记录恶心、呕吐、倦怠、头晕和对氧气吸入不适等不良反应发生情况。
结果：与C组比较，HF45组和HF65组术中最低SpO2明显升高、低氧血症发生率明显降低（P<0.05）。与HF25组比较，HF65组术中最低SpO2明显升高（P<0.05）。与HF65组比较，C组、HF25组和HF45组对氧气吸入不适发生率明显降低（P＜0.05）。四组呛咳VAS评分和发生率、乌拉地尔使用率和用量、术中痛苦回忆和愿意接受再次检查、恶心、呕吐、倦怠、头晕等不良反应的发生率差异无统计学意义。
结论：采用45 L/min或65 L/min流量的HFNC氧疗联合咪达唑仑复合高剂量阿芬太尼深度镇静，可明显升高纤维支气管镜检查患者术中最低SpO2、降低低氧血症发生率，45 L/min流量的HFNC氧疗可明显降低患者术中对氧气吸入的不适感。 |
| 英文摘要: |
Objective: To evaluate the safety and efficacy of high-flow nasal cannula (HFNC) oxygen therapy combined with midazolam and high-dose alfentanil for fiberoptic bronchoscopy under deep sedation.
Methods: A total of 160 patients, 88 males and 72 females, aged 18-64 years, BMI 15-36 kg/m2, ASA physical status Ⅰ or Ⅱ, who scheduled for painless fiberoptic bronchoscopy were included. Patients were divided into four groups using random number table method: the control group (group C, n = 38), group HF25 (n = 37), group HF45 (n = 39) and group HF65 (n = 37). Group C were offered conventional nasal catheter oxygen at 5 L/min, and group HF25, group HF45 and group HF65 were offered HFNC oxygen therapy at 25 L/min, 45 L/min and 65 L/min, respectively. All the patients were induced by sedation regimes with midazolam 0.05 mg/kg and alfentanil (17.5-30.0 μg/kg), and routine fiberoptic bronchoscopy was performed after the target depth of deep sedation was reached. The lowest SpO2 during the operation, the incidence of hypoxia during the operation, the score of cough VAS and the incidence of cough, the use and dosage of urapidil, the painful memory during the operation, and the willingness to undergo re-examination were recorded. The occurrence of adverse reactions such as nausea, vomiting, lethargy, dizziness, and discomfort with oxygen inhalation airflow were recorded.
Results: Compared with group C, the lowest SpO2 during the operation in groups HF45 and HF65 were significantly increased and the incidence of hypoxia were significantly decreased (P < 0.05). Compared with group HF25, the lowest SpO2 during the operation in group HF65 was significantly increased (P < 0.05). Compared with group HF65, the incidence of discomfort with oxygen inhalation airflow in groups C, HF25, and HF45 was significantly reduced (P < 0.05). There were no significant differences in the VAS score and incidence of coughing, the use and dosage of urapidil, intraoperative painful memory and willingness to undergo re-examination, nausea, vomiting, lethargy, dizziness, and other adverse reactions among the four groups.
Conclusion: 45 L/min or 65 L/min flow HFNC oxygen therapy can significantly increase the lowest SpO2 and reduce the incidence of hypoxia in fiberoptic bronchoscopy patients under deep sedation with midazolam and high-dose alfentanil during operation. Moreover, patients are less uncomfortable with the airflow of 45 L/min HFNC oxygen therapy. |
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