Liu Fengli, Zhang Chaojin, Wang Xiaoqiang, Qi Bo, Zheng Li, Zhao Yanhua, Yu Weifeng
Department of Anesthesiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China.
Key Laboratory of Anesthesiology, Shanghai Jiao Tong University, Ministry of Education, Shanghai, 200127, China.
BMC Anesthesiol. 2025 Jun 3;25(1):287. doi: 10.1186/s12871-025-03155-2.
Hypoxia is a common complication, particularly in gastrointestinal endoscopy due to respiratory depression induced by intravenous anesthesia with the use of propofol. This study aimed to investigate the efficacy and safety of high-flow nasal oxygen in preventing hypoxia during gastrointestinal endoscopy.
This single-center retrospective study included 900 patients undergoing gastrointestinal endoscopy at Renji Hospital, Shanghai Jiao Tong University School of Medicine, from June 15th 2023 to August 15th 2023. Patients were categorized into the high-flow nasal oxygen (HFNO) group using a high-flow-specific nasal cannula or the standard nasal oxygen (SNO) group using a standard nasal cannula. The primary outcome of this study was the incidence of hypoxia (mild hypoxia: 75% ≤ SpO < 90% for < 60 s, severe hypoxia: SpO < 75% or 75% ≤ SpO < 90% for > 60 s). Secondary outcomes included the incidence of subclinical respiratory depression (90% ≤ SpO < 95%) and adverse events associated with the nasal cannula. We used the propensity score matching (PSM) with a 1:1 ratio to balance the patient baseline characteristics.
884 patients were included in the analysis after PSM. The general characteristics of patients had no statistically significant difference between the two groups. The HFNO group demonstrated significantly better outcomes compared with SNO, including the lower incidence of hypoxia (0% vs. 5.66%, p < 0.001) and subclinical respiratory depression (1.36% vs. 12.67%, p < 0.001), and fewer adverse events associated with the nasal cannula (0% vs. 4.07%, p < 0.001). Furthermore, a multifactorial analysis identified body mass index (BMI) (HR = 1.43, 95% CI [1.17-1.76], p < 0.001) and sedation depth (HR = 10.31, 95% CI [3.68-28.88], p < 0.001) as risk factors for hypoxia in the SNO group.
HFNO emerges as a promising approach for preventing hypoxia during gastrointestinal endoscopy, offering a simple, effective, and non-invasive means of respiratory support.
缺氧是一种常见并发症，尤其是在胃肠内镜检查中，这是由于使用丙泊酚进行静脉麻醉引起的呼吸抑制。本研究旨在探讨高流量鼻导管吸氧在预防胃肠内镜检查期间缺氧方面的有效性和安全性。
这项单中心回顾性研究纳入了2023年6月15日至2023年8月15日在上海交通大学医学院附属仁济医院接受胃肠内镜检查的900例患者。患者被分为使用高流量专用鼻导管的高流量鼻导管吸氧（HFNO）组或使用标准鼻导管的标准鼻导管吸氧（SNO）组。本研究的主要结局是缺氧发生率（轻度缺氧：SpO₂<90%且持续<60秒，重度缺氧：SpO₂<75%或SpO₂在75%至90%之间且持续>60秒）。次要结局包括亚临床呼吸抑制（90%≤SpO₂<95%）的发生率以及与鼻导管相关的不良事件。我们采用1:1比例的倾向得分匹配（PSM）来平衡患者的基线特征。
PSM后884例患者纳入分析。两组患者的一般特征无统计学显著差异。与SNO组相比，HFNO组的结局显著更好，包括更低的缺氧发生率（0%对5.66%，p<0.001）和亚临床呼吸抑制发生率（1.36%对12.67%，p<0.001），以及更少的与鼻导管相关的不良事件（0%对4.07%，p<0.001）。此外，多因素分析确定体重指数（BMI）（HR=1.43，95%CI[1.17-1.76]，p<0.001）和镇静深度（HR=10.31，95%CI[3.68-28.88]，p<0.001）是SNO组缺氧的危险因素。
高流量鼻导管吸氧成为预防胃肠内镜检查期间缺氧的一种有前景的方法，提供了一种简单、有效且无创的呼吸支持手段。
