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经鼻湿化快速充气通气交换对儿童镇静胃镜检查中低氧血症发生率的影响：一项随机对照试验

Effect of transnasal humidified rapid-insufflation ventilatory exchange on the incidence of hypoxemia in sedated gastroscopy in children: a randomised controlled trial.

作者信息

Geng He, Yao Cuicui, Wu Lixin, Zhong Jinhong, Wang Ruoqiao, Chen Fang

机构信息

Department of Anaesthesiology, Shenzhen Children's Hospital of China Medical University, Shenzhen, China.

Department of Anaesthesiology, Shenzhen Children's Hospital, No. 7019 Yitian Road, Futian District, Shenzhen, 518026, Guangdong, China.

出版信息

BMC Pediatr. 2025 Sep 1;25(1):669. doi: 10.1186/s12887-025-06075-9.

DOI:10.1186/s12887-025-06075-9

PMID:40887614

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12400653/

Abstract

BACKGROUND

Transnasal humidified rapid-insufflation ventilatory exchange is a novel ventilation modality which can provide very high flow (up to 70 l/min) heated and humidified gas with adjustable temperatures (31-37 °C) and oxygen concentrations (21-100%). However its application in sedated gastroscopy in children has received little attention.

OBJECTIVE

To observe transnasal humidified rapid-insufflation ventilatory exchange in sedated gastroscopy in children and its effect on the incidence of hypoxemia.

DESIGN

A prospective randomized clinical trial.

SETTING

Endoscopy Center in Shenzhen Children's Hospital.

PATIENTS

120 children (ASA grade I-II), aged 6-12 years with a body mass index of 18-25 kg m-2, who underwent sedated gastroscopy at Shenzhen Children's Hospital between June 2022 and November 2022.

INTERVENTIONS

The participants were randomly assigned in a 1:1 ratio to receive transnasal humidified rapid-insufflation ventilatory exchange or nasal cannula oxygen therapy.

MAIN OUTCOME MEASURES

The primary outcome was hypoxemia incidence. The secondary outcomes included the lowest oxygen saturation index, duration of hypoxemia, incidence of adverse respiratory conditions, intervention rate, and endoscopist satisfaction.

RESULTS

Five children (8.3%) in thetransnasal humidified rapid-insufflation ventilatory exchange group had hypoxemia compared with 17 (28.3%) in the nasal cannula group, with a significant difference (P<0.01). The lowest oxygen saturation index in two groups shows no significant difference [98 (95, 99) vs. 98 (90, 99), P=0.087]. However compared with the nasal cannula group, the duration of hypoxaemia was significantly shorter (9.00 ± 1.73 s vs. 13.18 ± 3.49 s, 95% CI -6.63 to -1.72; P<0.01), the intervention rate was significantly lower (n=7, 11% vs. n=18, 30%; P<0.05), the incidence of adverse breathing complications was significantly lower (n=8, 13.3% vs. n=18, 30%; P<0.05), and the satisfaction of endoscopists was significantly higher (88.3% vs. 68.3%, P<0.05) in the transnasal humidified rapid-insufflation ventilatory exchange group.

CONCLUSION

Transnasal humidified rapid-insufflation ventilatory exchange can promote oxygenation reducing the incidence of hypoxemia in sedated gastroscopy in children.

TRIAL REGISTRATION

ChiCTR2200060799.

摘要

背景

经鼻湿化快速充气通气交换是一种新型通气方式，可提供高达70升/分钟的高流量、温度（31 - 37°C）和氧浓度（21 - 100%）可调节的加热湿化气体。然而，其在儿童镇静胃镜检查中的应用鲜受关注。

目的

观察经鼻湿化快速充气通气交换在儿童镇静胃镜检查中的应用及其对低氧血症发生率的影响。

设计

一项前瞻性随机临床试验。

地点

深圳儿童医院内镜中心。

患者

2022年6月至2022年11月在深圳儿童医院接受镇静胃镜检查的120名儿童（ASA分级I - II级），年龄6 - 12岁，体重指数为18 - 25 kg/m²。

干预措施

参与者按1:1比例随机分配，接受经鼻湿化快速充气通气交换或鼻导管吸氧治疗。

主要观察指标

主要观察指标为低氧血症发生率。次要观察指标包括最低氧饱和度指数、低氧血症持续时间、不良呼吸状况发生率、干预率和内镜医师满意度。

结果

经鼻湿化快速充气通气交换组有5名儿童（8.3%）发生低氧血症，而鼻导管组有17名（28.3%），差异有统计学意义（P<0.01）。两组的最低氧饱和度指数无显著差异[98（95，99）对98（90，99），P = 0.087]。然而，与鼻导管组相比，经鼻湿化快速充气通气交换组的低氧血症持续时间显著缩短（9.00 ± 1.73秒对13.18 ± 3.49秒，95%CI -6.63至 -1.72；P<0.01），干预率显著降低（n = 7，11%对n = 18，30%；P<0.05），不良呼吸并发症发生率显著降低（n = 8，13.3%对n = 18，30%；P<0.05），内镜医师满意度显著更高（88.3%对68.3%，P<0.05）。