简化的经鼻持续气道正压通气装置与鼻导管在肥胖患者深度镇静下结肠镜检查中的比较：一项随机临床试验。
Comparison of a simplified nasal continuous positive airways pressure device with nasal cannula in obese patients undergoing colonoscopy during deep sedation: A randomised clinical trial.
出版信息
Eur J Anaesthesiol. 2019 Sep;36(9):633-640. doi: 10.1097/EJA.0000000000001052.
BACKGROUND
Continuous positive airways pressure (CPAP) with a CPAP machine and mask has been shown to be more effective at minimising hypoxaemia than other devices under deep sedation. However, the efficacy of a new and simple CPAP device for spontaneously breathing obese patients during colonoscopy is unknown.
OBJECTIVE
We hypothesised that oxygenation and ventilation in obese patients under deep sedation during colonoscopy using CPAP via a new nasal mask (SuperNO2VA) would be better than routine care with oxygen supplementation via a nasal cannula.
DESIGN
Randomised study.
SETTING
Single-centre, June 2017 to October 2017.
PATIENTS
A total of 174 patients were enrolled and randomly assigned to Mask group or Control group. Thirty-eight patients were excluded and data from 136 patients underwent final analysis.
INTERVENTION
Patients in the Mask group were provided with nasal CPAP (10 cmH2O) at an oxygen flow rate of 15 l min. In the Control group, patients were given oxygen via a nasal cannula at a flow rate of 5 l min.
MAIN OUTCOME MEASURES
The primary outcome was elapsed time from anaesthesia induction to the first airway intervention.
RESULTS
The elapsed time from anaesthesia induction to the first airway intervention was 19 ± 10 min in the Mask group (n=63) vs. 10 ± 12 min in the Control group (n=73, P < 0.001). In all, 87.5% (56/64) of patients achieved the target CPAP value. More patients in the Control group (63%) received airway intervention than in the Mask group (22%) (P < 0.001). Hypoxaemia (pulse oximeter oxygen saturation, SpO2 < 90%) occurred more frequently in the Control group (22%) than in the Mask group (5%) (P = 0.004). Minute ventilationPostinduction/minute ventilationBaseline and minute ventilationProcedure-end/minute ventilationBaseline was lower in the Control group than in the Mask group (P = 0.007 and 0.001, respectively).
CONCLUSION
Application of a nasal mask at a target CPAP of 10 cmH2O improves ventilation and decreases the frequency and severity of hypoxaemia.
TRIAL REGISTRATION
NCT03139448, registered at ClinicalTrials.gov.
背景
与其他设备相比，持续气道正压通气（CPAP）联合 CPAP 机能更有效地减少深度镇静下的低氧血症。然而，在结肠镜检查中，对于自主呼吸的肥胖患者，新型简单 CPAP 设备的效果尚不清楚。
目的
我们假设在结肠镜检查中，肥胖患者在深度镇静下使用新型鼻罩（SuperNO2VA）进行 CPAP 治疗时，其氧合和通气情况要优于常规经鼻导管给氧。
设计
随机研究。
地点
单中心，2017 年 6 月至 2017 年 10 月。
患者
共纳入 174 例患者，随机分为面罩组或对照组。排除 38 例患者，对 136 例患者的数据进行了最终分析。
干预
面罩组患者接受 10cmH2O 的 CPAP 治疗，氧流量为 15L/min。对照组患者给予 5L/min 的氧流量经鼻导管给氧。
主要观察指标
主要观察指标为从麻醉诱导到第一次气道干预的时间。
结果
面罩组（n=63）从麻醉诱导到第一次气道干预的时间为 19±10min，而对照组（n=73）为 10±12min（P<0.001）。在面罩组中，有 87.5%（56/64）的患者达到了目标 CPAP 值。与面罩组（22%）相比，对照组（63%）中有更多的患者需要气道干预（P<0.001）。对照组（22%）低氧血症（脉搏血氧饱和度，SpO2<90%）的发生率高于面罩组（5%）（P=0.004）。与对照组相比，面罩组诱导后分钟通气量/分钟通气量基础值（P=0.007 和 0.001）和诱导后分钟通气量/基础值（P=0.007 和 0.001）更低。
结论
使用目标 CPAP 为 10cmH2O 的鼻罩可改善通气，并降低低氧血症的频率和严重程度。
试验注册
NCT03139448，ClinicalTrials.gov 注册。
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