Objective: To explore the effect of high-flow nasal catheter oxygen inhalation in preventing hypoxemia during endoscopic retrograde cholangiopancreatography (ERCP) surgery in elderly patients. Methods: From September 2021 to September 2022, 116 elderly patients (aged ≥ 70 years) who underwent elective ERCP in the Northern Theater General Hospital were prospectively selected, then divided into general nasal catheter oxygen inhalation group [group C, 31 males and 27 females, aged (79.8±6.4) years] and high-flow nasal catheter oxygen inhalation group [group H, 33 males and 25 females, aged (81.4±6.7) years], with 58 patients in each group. All patients were monitored for anesthesia by target-controlled infusion of propofol and remifentanil. The main outcome index was the incidence of intraoperative subclinical hypoxemia (90% ≤ SpO2 < 95%, duration >5 s), hypoxemia (75% < SpO2 < 90%, 5 s < duration ≤ 60 s) and severe hypoxemia (SpO2 < 75% or SpO2 < 90%, duration > 60 s). Secondary observation measures were SpO2 from T0 to T5 (T0, before anesthesia induction; T1, immediately after anesthesia induction; T2, endoscopic introduction; T3, duodenal papula intubation; T4, endoscopic withdrawal; T5, postoperative awakening), the arterial oxygen partial pressure (PaO2), carbon dioxide partial pressure (PaCO2) and pH at T0, 15 min after the induction and T5. Results: The incidence of intraoperative subclinical hypoxemia in group C and group H was 12.0% (7/58) and 3.4% (2/58) respectively, which showed no significant statistical difference (P=0.165) from each other. The incidence of intraoperative hypoxemia in group H was 8.6% (5/58), which was significantly lower than 31.0% (18/58) of group C (P=0.003). Neither group had intraoperative severe hypoxemia. SpO2 of group H were (98.2±0.9)%, (98.2±0.9)%, (97.8±1.7)% and (97.7±1.7)% at T1, T2, T3, T4, which were higher than (96.8±2.1)%, (96.4±3.0)%, (96.1±2.9)% and (96.4±3.4)% in group C (all P<0.05). PaO2 at 15 min after induction in group H was (240.5±46.7) mmHg (1 mmHg=0.133 kPa), which was higher than that of group C (170.6±33.4) mmHg (P<0.001). There was no statistically significant difference in pH and PaCO2 between the two groups of patients at each timepoint. Conclusion: High flow nasal catheter oxygen can effectively reduce the incidence of hypoxemia in ERCP in elderly patients.
目的： 探讨高流量鼻导管吸氧预防老年患者内镜逆行胰胆管造影（ERCP）手术中低氧血症的效果。 方法： 前瞻性选择2021年9月至2022年9月北部战区总医院择期行ERCP手术的老年患者116例（年龄≥70岁），按随机数字表法将患者分为普通鼻导管吸氧组［C组，男31例，女27例，年龄（79.8±6.4）岁］和高流量鼻导管吸氧组［H组，男33例，女25例，年龄（81.4±6.7）岁］，每组58例。所有患者均采用靶控输注丙泊酚-瑞芬太尼监测麻醉。主要观察指标为两组患者术中亚临床低氧血症［90%≤血氧饱和度（SpO2）<95%，持续时间>5 s］、低氧血症（75%≤SpO2<90%，5 s<持续时间≤60 s）和严重低氧血症（SpO2<75%或SpO2<90%，持续时间>60 s）发生率；次要观察指标为两组患者在麻醉诱导前（T0）、麻醉诱导后即刻（T1）、进镜时（T2）、十二指肠乳头插管时（T3）、退镜时（T4）、术后苏醒时（T5）不同时点的SpO2，以及在T0、诱导后15 min和T5时点的动脉血氧分压（PaO2）、二氧化碳分压（PaCO2）及酸碱度（pH）值。 结果： C组、H组患者术中亚临床低氧血症发生率分别为12.0%（7/58）、3.4%（2/58），差异无统计学意义（P=0.165）；H组患者术中低氧血症发生率为8.6%（5/58），明显低于C组的31.0%（18/58）（P=0.003）；两组患者术中均未发生严重低氧血症。H组患者在T1、T2、T3、T4时点的SpO2分别为（98.2±0.9）%、（98.2±0.9）%、（97.8±1.7）%、（97.7±1.7）%，均高于C组的（96.8±2.1）%、（96.4±3.0）%、（96.1±2.9）%、（96.4±3.4）%（均P<0.05）。H组患者诱导后15 min的PaO2为（240.5±46.7）mmHg（1 mmHg=0.133 kPa），高于C组的（170.6±33.4）mmHg（P<0.001）；两组患者各时点pH值及PaCO2比较，差异均无统计学意义（均P>0.05）。 结论： 高流量鼻导管吸氧可以有效降低老年患者ERCP术中低氧血症的发生率。.