【罂粟摘要】高流量与低流量口鼻联合氧疗对镇静期间低氧血症的影响：一项多中心随机对照试验

高流量与低流量口鼻联合氧疗对镇静期间低氧血症的影响：一项多中心随机对照试验

贵州医科大学高鸿教授课题组

翻译：吴学艳 编辑：佟睿 审校：曹莹

Part.01

总结

在内镜逆行胆管胰脏造影中，高流量或低流量鼻导管吸氧是否能减少镇静中低氧血症作用目前尚不清楚。此项多中心试验中，共纳入132例ASA≥3级、BMI＞30kg/m²、已知或者疑似伴有阻塞性睡眠呼吸暂停的患者；并随机分为高流量鼻吸氧组(最高可达60L/min, FIO₂为100%)或低流量鼻吸氧组(为4L/min)，低流量供氧组也通过护口器以4L/min给氧，总供氧量为8L/min。主要观察指标为低氧血症，定义为SpO₂< 90%，忽略持续时长。高流量吸氧组的低氧血症发生率为7.7%(5/65)，低流量吸氧组的低氧血症发生率为9.1%(6/66)(百分比差异为1.4%，95%CI为10.9~8.0;p = 0.77)。两组之间低氧血症的发生率无显著差异如：最低SpO2、经皮二氧化碳峰值、高碳酸(经皮二氧化碳>2.66 kPa);需要托下颌、置入鼻咽通气道、面罩通气或气管插管。延长氧疗时间后，主要观察指标仍无明显改善。在接受内镜逆行胆管胰脏造影的高危患者中，与口鼻联合低流量吸氧治疗相比，鼻高流量氧治疗并不能降低低氧血症、高碳酸血症或需气道干预的发生率。

Part.02

附图

Part.03

原始文献来源

Thiruvenkatarajan V,  Dharmalingam A,  Arenas G,,et al.Effect of high-flow vs. low-flow nasal plus mouthguard oxygen therapy on hypoxaemia during sedation: a multicentre randomised controlled trial.[J]. Anaesthesia 2021 Jun 28.

英文摘要

Effect of high-flow vs low-flow nasal plus mouthguard oxygen therapy on hypoxaemia during sedation: a multicentre randomised controlled trial

Summary

Whether high-flow vs. low-flow nasal oxygen reduces hypoxaemia for sedation during endoscopic retrograde cholangiopancreatography is currently unknown. In this multicentre trial, 132 patients ASA physical status 3 or higher, BMI > 30 kg.m^-2 or with known or suspected obstructive sleep apnoea were randomly allocated to high-flow nasal oxygen up to 60 l.min^-1 at 100% FiO₂ or low-flow nasal oxygen at 4 l.min^-1 . The low-flow nasal oxygen group also received oxygen at 4 l.min^-1 through an oxygenating mouthguard, totalling 8 l.min^-1 . Primary outcome was hypoxaemia, defined as SpO₂< 90% regardless of duration. Hypoxaemia occurred in 7.7% (5/65) of patients with high-flow and 9.1% (6/66) with low-flow nasal oxygen (percentage point difference -1.4%, 95%CI -10.9 to 8.0; p = 0.77). Between the groups, there were no significant differences in frequency of hypoxaemic episodes; lowest SpO₂ ; peak transcutaneous carbon dioxide; hypercarbia (transcutaneous carbon dioxide > 2.66 kPa from baseline); requirement of chin lift/jaw thrust; nasopharyngeal airway insertion; bag-mask ventilation; or tracheal intubation. Following adjustment for duration of the procedure, the primary outcome remained non-significant. In high-risk patients undergoing endoscopic retrograde cholangiopancreatography, oxygen therapy with high-flow nasal oxygen did not reduce the rate of hypoxaemia, hypercarbia or the need for airway interventions, compared with combined oral and nasal low-flow oxygen.