高流量鼻导管吸氧降低超高海拔全身麻醉下胃镜检查患者的低氧血症：一项随机对照试验。

High-flow nasal cannula oxygen reduced hypoxemia in patients undergoing gastroscopy under general anesthesia at ultra-high altitude: a randomized controlled trial.

机构信息

Department of Anesthesiology, Tibet Autonomous Region People's Hospital, Lhasa, Tibet, China.

Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

出版信息

BMC Anesthesiol. 2024 May 27;24(1):189. doi: 10.1186/s12871-024-02568-9.

DOI:10.1186/s12871-024-02568-9

PMID:38802783

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11129455/

Abstract

BACKGROUND

Hypoxemia can occur in people at ultra-high altitude (above 3500 m) even at rest, and patients undergoing gastroscopy under general anesthesia have higher risk of hypoxemia. Supplementary oxygen via standard nasal cannula (SNC) is the standard of care for most patients who undergo gastroscopy under general anesthesia, which provides oxygen flow up to 15 L/min. High-flow nasal cannula (HFNC) could deliver oxygen at a rate up to 60 L/min, which is recommended by the American Society of Anesthesiologists Practice Guidelines. We speculated that the benefit with HFNC is more prominent in high-altitude areas, and aimed to compare the incidence of hypoxemia during gastroscopy under general anesthesia at ultra-high altitude with oxygen supply via either HFNC or SNC.

METHODS

The trial was registered at at Chinese Clinical Trial Registry (ChiCTR2100045513; date of registration on 18/04/2021). Adult patients undergoing gastroscopy with anesthesia (estimated duration of anesthesia at ≥ 15 min) were randomized at a 1:1 ratio to receive HFNC oxygen or SNC oxygen. The primary outcome was hypoxemia (SpO < 90% for any duration). Secondary outcomes included severe hypoxemia (SpO < 75% for any duration or SpO < 90% but ≥ 75% for ≥ 60 s) and hypotension, as defined by reduction of mean arterial blood pressure by ≥ 25% from the baseline.

RESULTS

A total of 262 patients were enrolled: 129 in the HFNC group and 133 in the SNC group. All patients received the designated intervention. Student's t-test, Mann-Whitney U test and χ test were employed in the study. The rate of hypoxemia was 9.3% (12/129) in the HFNC group versus 36.8% (49/133) in the SNC group [risk ratio (95% confidence interval): 0.25(0.14-0.45); P < 0.001). The HFNC group also had lower rate of severe hypoxemia [0.0% (0/129) versus 11.3% (15/133); risk ratio (95% confidence interval): 0.03(0.00-0.55); P < 0.001, respectively]. The rate of hypotension did not differ between the 2 groups [22.5% (29/129) in HFNC group versus 21.1% (28/133) in SNC group; risk ratio (95% confidence interval): 1.07(0.67-1.69) ; P = 0.779].

CONCLUSION

HFNC oxygen reduced the incidence of hypoxemia during anesthesia in adult patients undergoing gastroscopy at ultra-high altitude.

摘要

背景

即使在休息时，超高海拔（高于 3500 米）的人也可能会发生低氧血症，而全身麻醉下接受胃镜检查的患者发生低氧血症的风险更高。标准鼻导管（SNC）补充氧气是大多数全身麻醉下接受胃镜检查患者的标准治疗方法，可提供高达 15 L/min 的氧气流量。高流量鼻导管（HFNC）可提供高达 60 L/min 的氧气流速，美国麻醉医师学会实践指南推荐使用。我们推测 HFNC 的益处在高海拔地区更为明显，旨在比较超高海拔地区全身麻醉下胃镜检查时使用 HFNC 或 SNC 供应氧气时低氧血症的发生率。

方法

该试验在中国临床试验注册中心（ChiCTR2100045513；注册日期为 2021 年 4 月 18 日）进行了注册。以 1:1 的比例随机将接受麻醉（估计麻醉持续时间≥15 分钟）的胃镜检查的成年患者分为 HFNC 氧组或 SNC 氧组。主要结局为低氧血症（任何持续时间的 SpO<90%）。次要结局包括严重低氧血症（任何持续时间的 SpO<75%或 SpO<90%但≥60 s）和低血压，定义为平均动脉血压从基线下降≥25%。

结果

共纳入 262 例患者：HFNC 组 129 例，SNC 组 133 例。所有患者均接受了指定的干预措施。研究中使用了学生 t 检验、Mann-Whitney U 检验和χ检验。HFNC 组低氧血症发生率为 9.3%（12/129），SNC 组为 36.8%（49/133）[风险比（95%置信区间）：0.25（0.14-0.45）；P<0.001）。HFNC 组严重低氧血症发生率也较低[0.0%（0/129）与 11.3%（15/133）；风险比（95%置信区间）：0.03（0.00-0.55）；P<0.001]。两组低血压发生率无差异[HFNC 组 22.5%（29/129）与 SNC 组 21.1%（28/133）；风险比（95%置信区间）：1.07（0.67-1.69）；P=0.779]。