Cai Q, Ma W, Wu C, Liu H, Wang S, Zhang G
Department of Anesthesiology, First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, China.
First Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou 510006, China.
Nan Fang Yi Ke Da Xue Xue Bao. 2022 Jul 20;42(7):1069-1074. doi: 10.12122/j.issn.1673-4254.2022.07.16.
To evaluate the safety of preoxygenation with high-flow nasal oxygenation in elderly patients during induction of general anesthesia with endotracheal intubation.
Fifty-six elderly patients without difficult airway were randomized equally into high-flow nasal oxygen group (HF group) and conventional mask oxygen group (M group). Preoxygenation was performed for 5 min before induction of general anesthesia and endotracheal intubation. Oxygenation was maintained during laryngoscopy in HF group, and ventilation lasted until laryngoscopy in M group. For all the patients, the general data, cross-sectional area (CSA) of the gastric antrum measured by ultrasonography, arterial partial pressure of oxygen (PaO), arterial partial pressure of carbon dioxide (PaCO) and arterial oxygen saturation (cSO) were recorded before preoxygenation (T1), at 5 min of preoxygenation (T2) and immediately after intubation (T3). The safety time of asphyxia, intubation time, times of mask ventilation and postoperative complications were compared between the two groups.
The general data were comparable between the two groups. After 5 min of preoxygenation, PaO and cSO were significantly increased in both groups, and PaO was significantly higher in HF group than in M group (=118.108 9.511, < 0.05). Both PaO and cSO decreased after intubation, but PaO decreased more slowly in HF group and still remained higher than that at T1; cSO decreased significantly in M group to a lower level than that at T1. Compared with those in M group, the patients in HF group showed a significantly longer safety time of asphyxia (=5.305, < 0.05) with fewer times of mask ventilation (= 6.720, < 0.05). PaCO increased after intubation in both groups but was comparable between the two groups (=3.138, > 0.05).
High-flow nasal oxygen is safe, simple and effective for pre-oxygenation, which, as compared with the conventional oxygen mask, improves arterial oxygen partial pressure and prolongs the safety time of asphyxia to ensure the safety of airway management during induction of general anesthesia in elderly patients with endotracheal intubation.
评估老年患者在气管插管全身麻醉诱导期间采用高流量鼻导管给氧进行预充氧的安全性。
将56例无困难气道的老年患者随机均分为高流量鼻导管给氧组（HF组）和传统面罩给氧组（M组）。在全身麻醉诱导和气管插管前进行5分钟的预充氧。HF组在喉镜检查期间维持氧合，M组通气持续至喉镜检查。记录所有患者在预充氧前（T1）、预充氧5分钟时（T2）和插管后即刻（T3）的一般资料、超声测量的胃窦横截面积（CSA）、动脉血氧分压（PaO）、动脉血二氧化碳分压（PaCO）和动脉血氧饱和度（cSO）。比较两组的窒息安全时间、插管时间、面罩通气次数和术后并发症。
两组的一般资料具有可比性。预充氧5分钟后，两组的PaO和cSO均显著升高，且HF组的PaO显著高于M组（=118.108 9.511，<0.05）。插管后PaO和cSO均降低，但HF组的PaO下降较慢，仍高于T1时；M组的cSO显著降低至低于T1时的水平。与M组相比，HF组患者的窒息安全时间显著延长（=5.305，<0.05），面罩通气次数更少（= 6.720，<0.05）。两组插管后PaCO均升高，但两组之间具有可比性（=3.138，>0.05）。
高流量鼻导管给氧用于预充氧安全、简便且有效，与传统氧面罩相比，可提高动脉血氧分压，延长窒息安全时间，确保老年患者气管插管全身麻醉诱导期间气道管理的安全性。
