高流量鼻导管在支气管镜检查患者中减少低氧血症事件的应用：一项随机试验的系统评价和荟萃分析。
High-flow nasal cannula for reducing hypoxemic events in patients undergoing bronchoscopy: A systematic review and meta-analysis of randomized trials.
机构信息
Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.
Department of Physical Therapy, Shu-Zen Junior College of Medicine and Management, Kaohsiung City, Taiwan.
出版信息
PLoS One. 2021 Dec 1;16(12):e0260716. doi: 10.1371/journal.pone.0260716. eCollection 2021.
BACKGROUND
Patients undergoing bronchoscopic procedures may develop hypoxemia and severe complications. High-flow nasal cannula (HFNC) may prevent hypoxemic events during bronchoscopy. We conducted a systematic review of randomized controlled trials (RCTs) to evaluate the effectiveness of HFNC in these patients.
METHODS
We conducted a search in PubMed, Embase, and the Cochrane Library for RCTs published before November 2021. Individual effect sizes were standardized, and a meta-analysis was performed to calculate the pooled effect size using random-effects models. The primary outcome was the incidence of hypoxemic events (oxygen saturation [SpO2] < 90%) during bronchoscopy. Secondary outcomes included the incidence of interrupted bronchoscopy due to desaturation, lowest SpO2 during bronchoscopy, partial pressure of oxygen (PaO2), partial pressure of carbon dioxide (PaCO2), end-tidal CO2 (EtCO2) at the end of bronchoscopy, and the incidence of intubation after the procedure.
RESULTS
Five trials involving 257 patients were reviewed. The incidence of hypoxemic events was lower in the HFNC group than in the conventional oxygen therapy group (risk ratio, 0.25; 95% confidence interval [CI], 0.14-0.42). The lowest SpO2 during the procedure was significantly higher in the HFNC group than in the conventional oxygen therapy group (weighted mean difference [WMD], 7.12; 95% CI, 5.39-8.84). PaO2 at the end of the procedure was significantly higher in the HFNC group than in the conventional oxygen therapy group (WMD, 20.36; 95% CI, 0.30-40.42). The incidence of interrupted bronchoscopy due to desaturation, PaCO2 and EtCO2 at the end of the procedure, and the incidence of intubation after the procedure were not significantly different between groups.
CONCLUSIONS
HFNC may reduce the incidence of hypoxemic events and improve oxygenation in patients undergoing bronchoscopy.
背景
接受支气管镜检查的患者可能会出现低氧血症和严重并发症。高流量鼻导管（HFNC）可预防支气管镜检查期间的低氧血症事件。我们对随机对照试验（RCT）进行了系统评价，以评估 HFNC 在这些患者中的效果。
方法
我们在 PubMed、Embase 和 Cochrane Library 中检索了截至 2021 年 11 月发表的 RCT。对个体效应量进行标准化，并使用随机效应模型进行荟萃分析以计算合并效应量。主要结局是支气管镜检查期间低氧血症事件（血氧饱和度[SpO2]＜90%）的发生率。次要结局包括因低氧血症而中断的支气管镜检查发生率、支气管镜检查期间的最低 SpO2、氧分压（PaO2）、二氧化碳分压（PaCO2）、支气管镜检查结束时的呼气末二氧化碳（EtCO2）以及术后插管的发生率。
结果
共纳入 5 项涉及 257 例患者的试验。HFNC 组低氧血症事件的发生率低于常规氧疗组（风险比，0.25；95%置信区间[CI]，0.14-0.42）。HFNC 组在支气管镜检查期间的最低 SpO2 明显高于常规氧疗组（加权均数差[WMD]，7.12；95%CI，5.39-8.84）。HFNC 组在支气管镜检查结束时的 PaO2 明显高于常规氧疗组（WMD，20.36；95%CI，0.30-40.42）。两组间因低氧血症而中断的支气管镜检查发生率、支气管镜检查结束时的 PaCO2 和 EtCO2、以及术后插管的发生率无明显差异。
结论
HFNC 可能降低接受支气管镜检查患者的低氧血症事件发生率并改善氧合。
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