经鼻高流量氧疗在胃减容术后患者中的应用

目的探讨经鼻高流量氧疗（HFNC）可否改善肥胖症患者胃减容术后低氧血症，提升术后呼吸舒适度。 方法采用前瞻性随机对照研究，选择2019年10月到2020年9月于上海市第十人民医院接受胃减容术后转入急诊ICU的肥胖患者为研究对象，根据随机抛硬币法将患者分为高流量组（22例，经鼻高流量氧疗）与传统氧疗组（28例，传统氧疗）。比较2组间患者一般资料，包括性别、年龄、体质量指数（BMI）、是否合并有睡眠呼吸暂停综合征（OSAHS）等，记录入科0.5 h、2 h、24 h动脉血气分析相关指标，夜间（20∶00-次日08∶00）心率（HR）、血氧饱和度（SpO₂）、最低SpO₂、氧减次数、呼吸暂停低通气指数（AHI）及舒适度等相关临床指标。 结果（1）2组患者年龄、性别及BMI比较，差异无统计学意义（P＞0.05）。（2）组间比较，高流量组患者2 h的PO₂、氧合指数及入科24 h PO₂、氧合指数明显高于传统氧疗组，PCO₂低于传统氧疗组，差异有统计学意义（P＜0.05），其余各指标组间比较，差异均无统计学意义（P＞0.05）。组内比较，高流量组入科2 h及24 h的pH、PO₂、氧合指数明显高于入科0.5 h时，差异有统计学意义（P＜0.05）；传统氧疗组入科2 h的pH及24 h的pH、PO₂、氧合指数明显高于入科0.5 h时，差异有统计学意义（P＜0.05），其余各指标不同时点组内比较，差异均无统计学意义（P＞0.05）。（3）12 h夜间睡眠监测相关指标中，高流量组患者夜间SpO₂、最低SpO₂高于传统氧疗组，HR、氧减次数低于传统氧疗组，差异有统计学意义（P＜0.05），而2组间AHI比较，差异无统计学意义（P＞0.05）。（4）高流量组患者主观舒适度优于传统氧疗组，差异有统计学意义（P<0.05）。 结论HFNC可以有效降低胃减容术后患者出现低氧血症风险，提升患者可接受度及主观舒适感。

Application of high-flow nasal cannula oxygen therapy in patients after gastric volume reduction

ObjectiveTo explore whether high-flow nasal cannula (HFNC) oxygen therapy can improve postoperative hypoxemia and improve patient comfort in obese patients after gastric volume reduction. MethodsObese patients who were transferred to the EICU after gastric volume reduction in Shanghai Tenth People's Hospital from October 2019 to September 2020 were selected as the study subjects by using prospective randomized controlled clinical research methods; according to the random coin throwing method, they were divided into HFNC group (n=22) and traditional oxygen therapy group (n=28). Patients' general information (gender, age, BMI, whether they have OSAHS), blood gas results at 0.5 h, 2 h and 24 h after admission, average heart rate at night (20：00-08：00 the next day), average oxygen saturation, minimum oxygen saturation, number of oxygen reduction, apnea hypopnea index(AHI) and comfort were compared between the two groups. Results(1) There was no statistical difference in age, sex and BMI between the two groups; (2) The PO₂ and oxygenation index at 2 h, 24 h after admission in the high flow group were significantly higher than those in the traditional oxygen therapy group, and PCO₂ was lower than that in the traditional oxygen therapy group, with statistical difference (P＜0.05), and others were not statistically different between the two groups at different times. In high flow group, 2 h pH, PO₂ and oxygenation index were significantly higher than 0.5 h, with statistical difference (P＜0.05); the pH at 2 h and pH, PO₂, oxygenation index at 24 h after admission were significantly higher than 0.5 h after admission (P＜0.05). There were no significant differences in two group at different times. (3) Among the indicators related to the 12 h nocturnal sleep monitoring, the average oxygen saturation and minimum oxygen saturation at night in the high flow group were higher than those in the traditional oxygen therapy group, and the number of oxygen reduction and average heart rate were lower than those in the traditional oxygen therapy group, with statistical differences (P＜0.05), while there was no statistical difference in AHI between the two groups. (4) In general data, the subjective comfort of patients in the HFNC group was better than that in the traditional oxygen therapy group, with statistical difference (P＜0.05). ConclusionHFNC can effectively alleviate hypoxemia in obese patients after gastric volume reduction surgery and build better subjective comfort in them.