湿化高流量鼻导管通气在老年肥胖患者行无痛胃镜检查中的应用

目的观察湿化高流量鼻导管通气（HFNC）在老年肥胖患者行无痛胃镜检查中应用的有效性和安全性。方法选择行无痛胃镜患者100例（ASAⅠ～Ⅱ级），年龄60～88岁，BMI≥30 kg/m2，随机分成两组，每组50例。C组给予传统鼻导管吸氧，氧流量3～5 L/min；H组采用呼吸湿化治疗仪（广州鲸科HF807C型）给予HFNC，氧流量30 L/min，FiO2100%，温度37℃。3 min后静脉注射丙泊酚15～25 mg/kg，进入睡眠状态时，H组氧流量调整为60 L/min，而C组氧流量不变，随后开始胃镜操作。检查中根据患者反应情况如心率加快、呛咳、体动、RSS≤4等，酌情每次追加丙泊酚02～05 mg/kg。记录患者丙泊酚用量、胃镜检查时间和苏醒时间；记录麻醉给药前（T0）、胃镜检查后1 min （T1）、胃镜检查后3 min（T2）、胃镜检查后5 min（T3）、胃镜结束时（T4）等5个时间点平均动脉压（MAP）、心率（HR）和血氧饱和度（SpO2）；记录与呼吸相关不良事件及干预情况，不良反应的发生率，询问患者和胃镜操作者的主观满意度。结果与C组比较，H组胃镜检查时间明显减少（P＜005）；SpO2在T1～T4时点明显高于C组（P＜005）；亚临床呼吸抑制、缺氧和严重缺氧的发生率明显降低（P＜005），托下颌和面罩通气等干预低氧措施的使用率降低（P＜005）；上呼吸道梗阻、心律失常、心动过速和呛咳等不良反应的发生率明显降低（P＜005）；胃镜操作者的主观满意度更高（P＜005）。结论HFNC用于老年肥胖患者行无痛胃镜检查能有效预防操作中血氧饱和度的下降，改善患者氧合状态，减少呼吸相关不良事件及干预情况，降低上呼吸道梗阻、心律失常、心动过速和呛咳等不良反应的发生率，缩短胃镜检查时间，提高胃镜操作者的满意度，推荐在临床中使用。

Applications of humidified high flow nasal cannula on painless gastroscopy in elderly obese patients

Objective To observe the effects and safety of humidified high flow nasal cannula on painless gastroscopy in elderly obese patients. Methods One hundred patients who needed painless gastroscopy （ASA Ⅰ～Ⅱ）, aged 60 to 88 years, with BMI ≥30 kg/m2, were randomly divided into 2 groups （group C and group H）, with 50 cases in each group. In group C, oxygen was inhaled through the traditional nasal catheter with oxygen flow of 3-5 L/min, while oxygen at FiO2 of 100% and temperature of 37℃was inhaled via humidified high flow nasal cannula with oxygen flow of 30 L/min in group H. Three minutes later, intravenous injection of 15-25 mg/kg propofol was given to the patients. When they entered the sleep state, the oxygen flow in group H was adjusted to 60 L/min, while the oxygen flow in group C was unchanged. Thengastroscopy was performed. Propofol 02-05 mg/kg was added each time according to the patient′s response, such as increased heart rate, coughing, body movement, RSS≤4, etc. The dosage of propofol, the time of gastroscopy procedure and recovery were recorded. MAP, HR and SpO2 were recorded at 5 time points, such as before anesthesia （T0）, 1 min after gastroscopy（T1）, 3 min after gastroscopy （T2）, 5 min after gastroscopy （T3）, and at the end of gastroscopy （T4）. Respiration-related adverse events, interventions, incidence of adverse reactions, and subjective satisfaction of patients and gastroscopy operators were recorded. Results Compared with group C, in group H, the time of gastroscopy was significantly decreased （P<005）, SpO2 was significantly higher at T1-T4 （P<005）, the incidences of subclinical respiratory depression, hypoxia and severe hypoxia were decreased significantly （P<005）, the utilization rate of intervention measures such as mandibular support and mask ventilation decreased significantly （P<005）, the incidences of adverse reactions such as upper respiratory tract obstruction, arrhythmia, tachycardia and choking were significantly decreased （P<005）, and the subjective satisfaction of gastroscope operators was higher（P<005）. Conclusion Humidified high flow nasal cannula on painless gastroscopy in elderly obese patients can effectively prevent the decrease of SpO2 during gastroscopy, improve the oxygenation state of patients, reduce respiratory-related adverse events and interventions, reduce the incidence of adverse reactions such as upper airway obstruction, arrhythmia, tachycardia and cough, shorten the time of gastroscopy and improve the satisfaction of gastroscopy operators. It is recommended to use in clinical practice.