[Effect of high flow nasal catheter oxygen to prevent hypoxemia in endoscopic retrograde cholangiopancreatography surgery in aged].

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% ≤ SpO ₂ < 95%, duration >5 s), hypoxemia (75% < SpO ₂ < 90%, 5 s < duration ≤ 60 s) and severe hypoxemia (SpO ₂ < 75% or SpO ₂ < 90%, duration > 60 s). Secondary observation measures were SpO ₂ from T ₀ to T ₅ (T ₀ , before anesthesia induction; T ₁ , immediately after anesthesia induction; T ₂ , endoscopic introduction; T ₃ , duodenal papula intubation; T ₄ , endoscopic withdrawal; T ₅ , postoperative awakening), the arterial oxygen partial pressure (PaO ₂ ), carbon dioxide partial pressure (PaCO ₂ ) and pH at T ₀ , 15 min after the induction and T ₅ . 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. SpO ₂ of group H were (98.2±0.9)%, (98.2±0.9)%, (97.8±1.7)% and (97.7±1.7)% at T ₁ , T ₂ , T _3, T ₄ , 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). PaO ₂ 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 PaCO ₂ 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.