高流量鼻氧疗在妊娠患者快速序贯诱导期间维持母体氧合的效果：一项前瞻性随机临床试验。

BACKGROUND

High-flow nasal oxygenation (HFNO) for pre-oxygenation in rapid sequence induction (RSI) has only been assessed in volunteer parturients without intubation.

OBJECTIVES

To evaluate the efficacy of HFNO in comparison with the conventional facemask for oxygenation during RSI for caesarean section under general anaesthesia.

SETTING

Operating room in a tertiary hospital.

DESIGN

Prospective randomised, controlled study.

PARTICIPANTS

Thirty-four healthy parturients undergoing general anaesthesia for caesarean section.

INTERVENTIONS

Parturients were randomly assigned to HFNO or standard facemask (SFM) group.

MAIN OUTCOME MEASURES

The primary outcome measure was the PaO2 immediately after intubation. Secondary outcomes included lowest saturation throughout the intubation procedure, end-tidal oxygen concentration (EtO2) on commencing ventilation, blood gas analysis (pH, PaCO2), fetal outcomes and intubation-related adverse events.

RESULTS

PaO2 in the HFNO group was significantly higher than that in SFM group (441.41 ± 46.73 mmHg versus 328.71 ± 72.80 mmHg, P < 0.0001). The EtO2 concentration in the HFNO group was higher than that in the SFM group (86.71 ± 4.12% versus 76.94 ± 7.74%, P < 0.0001). Compared to baseline, PaCO2 immediately after intubation also increased significantly in both groups (HFNO group: 30.87 ± 2.50 mmHg versus 38.28 ± 3.18 mmHg; SFM group: 29.82 ± 2.57 mmHg versus 38.05 ± 5.76 mmHg, P < 0.0001), but there was no difference in PaCO2 between the two groups. There was no difference in lowest saturation, intubation times, duration of apnoea, pH value or fetal outcomes.

CONCLUSIONS

Compared with SFM, HFNO provided a higher PaO2 and EtO2 immediately after intubation in parturients. HFNO is safe as a method of oxygenation during RSI in parturients undergoing general anaesthesia for caesarean section.

TRIAL REGISTRATION

Clinical trial ChiCTR1900023121.

背景

高流量鼻氧（HFNO）在快速序贯诱导（RSI）中的预充氧作用仅在未插管的志愿者中进行了评估。

目的

评估 HFNO 与常规面罩在全身麻醉下剖宫产 RSI 期间氧合的效果。

设置

三级医院的手术室。

设计

前瞻性随机对照研究。

参与者

34 名健康产妇，全身麻醉下剖宫产。

干预

产妇随机分配到 HFNO 或标准面罩（SFM）组。

主要观察指标

主要观察指标为插管后即刻的 PaO2。次要结局包括插管过程中最低饱和度、开始通气时的呼气末氧浓度（EtO2）、血气分析（pH 值、PaCO2）、胎儿结局和插管相关不良事件。

结果

HFNO 组的 PaO2 明显高于 SFM 组（441.41±46.73mmHg 与 328.71±72.80mmHg，P<0.0001）。HFNO 组的 EtO2 浓度高于 SFM 组（86.71±4.12%与 76.94±7.74%，P<0.0001）。与基线相比，两组插管后即刻 PaCO2 均明显升高（HFNO 组：30.87±2.50mmHg 与 38.28±3.18mmHg；SFM 组：29.82±2.57mmHg 与 38.05±5.76mmHg，P<0.0001），但两组间 PaCO2 无差异。最低饱和度、插管时间、无通气时间、pH 值和胎儿结局无差异。

结论

与 SFM 相比，HFNO 可在产妇插管后即刻提供更高的 PaO2 和 EtO2。HFNO 作为全身麻醉下剖宫产 RSI 期间的氧合方法是安全的。

试验注册

临床试验 ChiCTR1900023121。

The efficacy of high flow nasal oxygenation for maintaining maternal oxygenation during rapid sequence induction in pregnancy: A prospective randomised clinical trial.

机构信息

出版信息