孕妇高流量鼻氧与标准流量面罩预充氧的随机生理研究
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High-flow nasal oxygen vs. standard flow-rate facemask pre-oxygenation in pregnant patients: a randomised physiological study
背景与目的
高流量鼻氧已经被证明提供了有效的预给氧和延长非怀孕患者插管时的呼吸暂停时间。我们的目的是比较经鼻导管高流量鼻充氧与通过紧扣面罩给予标准氧流量之间预充氧的效果。
方 法
将40例健康产妇随机分为两组，每例均进行3分钟潮气量呼吸和30秒潮气量呼吸，然后进行8次肺活量呼吸。
结 果
3分钟潮气量呼吸时，高流量鼻氧和标准流量面罩预充氧的估计边际平均值分别为87.4%（95%ci 85.5-89.2%）和91.0%（95%ci 89.3-92.7%），p=0.02；有8次肺活量呼吸时，估计的边缘平均值分别为85.9%（95%ci 84.1-87.7%）和91.8%（95%ci 90.1-93.4%，p<0.0001）。此外，与标准流量面罩相比，高流量鼻氧不能可靠地达到平均潮气末氧浓度≥90%。
结 论
在这项生理学研究中，高流量鼻氧预氧对健康足月产妇的效果比标准流量面罩预充氧差。
原始文献摘要
W. Shippam, R. Preston, J. Douglas et，al.High-flow nasal oxygen vs. standard flow-rate facemask pre-oxygenation in pregnant patients: a randomised physiological study[J]Anaesthesia 2019 Apr;74(4) DOI：10.1111/anae.14567
High-flow nasal oxygen has been shown to provide effective pre-oxygenation and prolong apnoeic time during intubation attempts in non-pregnant patients. We aimed to compare pre-oxygenation using high-flow nasal oxygen (30–70 l.min1 oxygen flow) via nasal prongs with standard 15 l.min1 oxygen breathing via a tight-fitting facemask. Forty healthy parturients were randomly allocated to these two groups, and furthermore each patient underwent the selected pre-oxygenation method with both 3-min tidal volume breathing and 30s tidal breathing followed by eight vital capacity breaths. With 3-min tidal volume breathing, the respective estimated marginal means for high-flow nasal oxygen and standard flow rate facemask pre-oxygenation were 87.4% (95%CI 85.5–89.2%) and 91.0% (95%CI 89.3–92.7%), p = 0.02; with eight vital capacity breaths the estimated marginal means were 85.9% (95%CI 84.1–87.7%) and 91.8% (95%CI 90.1–93.4%, p < 0.0001). Furthermore,high-flow nasal oxygen did not reliably achieve a mean end-tidal oxygen concentration ≥ 90% compared with the standard flow rate facemask. In this physiological study, high-flow nasal oxygen pre-oxygenation performed worse than standard flow rate facemask pre-oxygenation in healthy term parturients.
麻醉学文献进展分享
贵州医科大学高鸿教授课题组
翻译：牛振瑛 编辑：何幼芹 审校：王贵龙