Kurata Shinji, Sanuki Takuro, Higuchi Hitoshi, Miyawaki Takuya, Watanabe Seiji, Maeda Shigeru, Sato Shuntaro, Pinkham Max, Tatkov Stanislav, Ayuse Takao
Division of Clinical Physiology, Department of Translational Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
Department of Dental Anesthesiology, Kanagawa Dental University, Kanagawa, Japan.
Jpn Dent Sci Rev. 2022 Nov;58:179-182. doi: 10.1016/j.jdsr.2022.05.003. Epub 2022 Jun 4.
Rationale: Nasal high-flow (NHF), a new method for respiratory management during procedural sedation, has greater advantages than conventional nasal therapy with oxygen. However, its clinical relevance for patients undergoing oral maxillofacial surgery and/or dental treatment remains uncertain and controversial, due to a paucity of studies. This scoping review compared and evaluated NHF and conventional nasal therapy with oxygen in patients undergoing oral maxillofacial surgery and/or dental treatment.
A literature search of two public electronic databases was conducted, and English writing randomized controlled trials (RCTs) of nasal high flow during dental procedure with sedation reviewed. The primary and secondary outcomes of interest were the incidence of hypoxemia and hypercapnia during sedation and the need for intervention to relieve upper airway obstruction, respectively.
The search strategy yielded 7 studies, of which three RCTs met our eligibility criteria, with a total of 78 patients. Compared with conventional nasal therapy with oxygen, NHF significantly reduced the incidence of hypoxemia and hypercapnia during procedural sedation.
NHF can maintain oxygenation and possibly prevent hypercapnia in patients undergoing dental treatment. Additional RCTs are needed to clarify and confirm these findings.
理论依据：鼻高流量通气（NHF）作为一种在程序镇静期间进行呼吸管理的新方法，比传统的经鼻给氧疗法具有更大优势。然而，由于研究较少，其在接受口腔颌面外科手术和/或牙科治疗的患者中的临床相关性仍不确定且存在争议。本范围综述比较并评估了NHF与传统经鼻给氧疗法在接受口腔颌面外科手术和/或牙科治疗的患者中的应用。
对两个公共电子数据库进行文献检索，并对牙科手术镇静期间鼻高流量通气的英文随机对照试验（RCT）进行综述。感兴趣的主要和次要结局分别是镇静期间低氧血症和高碳酸血症的发生率以及缓解上呼吸道梗阻所需的干预措施。
检索策略产生了7项研究，其中3项RCT符合我们的纳入标准，共有78例患者。与传统经鼻给氧疗法相比，NHF显著降低了程序镇静期间低氧血症和高碳酸血症的发生率。
NHF可维持接受牙科治疗患者的氧合，并可能预防高碳酸血症。需要更多的随机对照试验来阐明和证实这些发现。
