【罂粟摘要】术中高流量鼻氧的有效性:一项系统回顾和Meta分析

术中高流量鼻氧的有效性:一项系统回顾和Meta分析

贵州医科大学  高鸿教授课题组

翻译：潘志军  编辑：佟睿  审校：曹莹

背景

高流量鼻氧(HFNO)越来越多地用于重症监护病房的低氧血症和呼吸衰竭患者的管理。然而，高流量鼻导管氧疗预防术中低氧血症的效果尚不明确。本系统回顾的目的是比较手术患者术中HFNO与常规氧合的患者氧合和呼气末CO₂ （E_TCO₂）。

方法

我们检索了直至2020年2月标准数据库内的文献。研究包括术中使用高流量鼻导管氧疗的4种结果中的1种:(1)氧（O₂）饱和度降低，(2)最低O₂饱和度，(3)安全呼吸暂停时间，或(4)E_TCO₂。术中分为2个阶段:全麻诱导期和镇静下无气管插管手术期。

结果

八项随机对照试验（RCT；4项诱导，4项程序，共2314例患者）被纳入系统回顾和Meta分析。我们发现HFNO与传统氧合对照组相比，术中氧饱和度降低的风险较低；诱导时的优势比（OR；95%置信区间[CI]）为0.06（0.01-0.59，P =0 .02），手术期间OR（95% CI）为0.09（0.05-0.18；P <0 . 001）。与传统氧合相比，HFNO 的最低 O₂ 饱和度更高；诱导时的平均差（MD） (95% CI)为5.1% (3.3–6.9; P<0 .001)，在手术过程中，MD (95% CI)为4.0% (1.8-6.2; P <0.001）。与常规氧合相比，HFNO诱导时允许的安全呼吸暂停时间更长，MD（95% CI）为33.4秒（16.8-50.1；P <0.001）。HFNO组和常规氧合组在诱导时的E_TCO₂没有显着差异。

结论

这项系统回顾和Meta分析显示，在术中，HFNO与传统氧合相比，降低了O₂去饱和的风险，增加了最低O₂饱和度和允许安全呼吸暂停时间。对于低氧血症风险较高的患者，在麻醉诱导和手术过程中，应考虑在镇静下不经气管插管的情况下使用HFNO。

The Effectiveness of High-Flow Nasal Oxygen  During the Intraoperative Period: A Systematic  Review and Meta-analysis

Abstract

Background: High-flow nasal oxygen (HFNO) is increasingly being used in intensive care units for management of hypoxemia and respiratory failure. However, the effectiveness of HFNO for preventing hypoxemia in the intraoperative period is unclear. The purpose of this systematic review was to compare patient oxygenation and end-tidal CO₂ (E_TCO₂), between HFNO and conventional oxygenation, during the intraoperative period in surgical patients.

Methods: Standard databases were searched from inception to February 2020. Studies involving intraoperative use of HFNO with 1 of the 4 outcomes: (1) oxygen (O₂) desaturation, (2) minimum O₂ saturation, (3) safe apnea time, or (4) Etco2 were included. Intraoperative period was divided into 2 phases: at induction with general anesthesia and during surgical procedure under sedation without tracheal intubation.

Results: Eight randomized controlled trials (RCTs; 4 induction, 4 procedure, 2314 patients) were included for systematic review and meta-analyses. We found the risk of intraoperative O₂ desaturation was lower in HFNO versus conventional oxygenation control group; at induction with an odds ratio (OR; 95% confidence interval [CI]) of 0.06 (0.01–0.59, P = .02), and during procedure, OR (95% CI) of 0.09 (0.05–0.18; P < .001). The minimum O₂ saturation was higher in HFNO versus conventional oxygenation; at induction by a mean difference (MD) (95% CI) of 5.1% (3.3–6.9; P < .001), and during procedure, by a MD (95% CI) of 4.0% (1.8–6.2; P < .001). Safe apnea time at induction was longer in HFNO versus conventional oxygenation by a MD (95% CI) of 33.4 seconds (16.8–50.1; P < .001). Etco2 at induction was not significantly different between HFNO and conventional oxygenation groups.

Conclusions: This systematic review and meta-analysis show that, in the intraoperative setting, HFNO compared to conventional oxygenation reduces the risk of O₂ desaturation, increases minimum O₂ saturation, and safe apnea time. HFNO should be considered for anesthesia induction and during surgical procedures under sedation without tracheal intubation in patients at higher risk of hypoxemia.

　罂粟花　

翻译：潘志军

编辑：佟睿

审校：曹莹