【罂粟摘要】在快速序贯诱导过程中使用高流量鼻氧预充氧或面罩预充氧对患者血氧饱和度影响的比较

在快速序贯诱导过程中使用高流量鼻氧预充氧或面罩预充氧对患者血氧饱和度影响的比较

贵州医科大学麻醉与心脏电生理课题组  

翻译：张中伟 编辑：陈锐 审校：曹莹

HOLIDAY  

背景

在急诊手术患者的快速序贯诱导过程中，使用高流量鼻氧进行预充氧可以减少患者氧饱和度降低的风险。以前的研究都是单中心的，而且通常在有限的环境中进行。这项随机、多国家、多中心的试验对急诊手术快速序贯诱导中高流量鼻氧预充氧和标准面罩预充氧的效果进行了比较。  

HOLIDAY  

方法

本研究纳入来自6个瑞典中心和1个瑞士中心的350名接受急诊手术的成人患者，均接受快速序贯诱导，并随机使用高流量鼻氧或标准密闭面罩进行100%预充氧。主要观察指标是从预充氧开始到气管插管后1分钟，氧饱和度<93%的患者数量。

HOLIDAY  

结果

研究人员分析了349名患者(高流量鼻氧组174名，口罩组175名)的试验数据。高流量鼻氧组和面罩组分别有5例(2.9%)和6例(3.4%)患者的氧饱和度降至93%以下，差异无统计学意义(p = 0.77)。在术后恢复期间，不存在氧饱和度降低的风险。两组患者在气管插管后第一次测得的呼气末二氧化碳水平和出现反流症状的患者数量上没有差异。

HOLIDAY 结论

高流量鼻氧治疗在预充氧期间能够维持足够的氧气水平，以进行快速序贯诱导。

HOLIDAY   原始文献来源  

A. Sj€oblom, J. Broms, M. Hedberg.Pre-oxygenation using high-flow nasal oxygen vs. Tight facemask during rapid sequence induction[J]. Anaesthesia(29 December 2020）：1   

Pre-oxygenation using high-flow nasal oxygen vs. tight

facemask during rapid sequence induction

Summary

Pre-oxygenation using high-flow nasal oxygen can decrease the risk of desaturation during rapid sequence induction in patients undergoing emergency surgery. Previous studies were single-centre and often in limited

settings. This randomised, international, multicentre trial compared high-flow nasal oxygen with standard facemask pre-oxygenation for rapid sequence induction in emergency surgery at all hours of the day and night. A total of 350 adult patients from six centres in Sweden and one in Switzerland undergoing emergency surgery where rapid sequence induction was required were included and randomly allocated to pre-oxygenation with 100% oxygen using high-flow nasal oxygen or a standard tight-fitting facemask. The primary outcome was the number of patients developing oxygen saturations <93% from the start of pre-oxygenation until 1 min after tracheal intubation. Data from 349 of 350 patients who entered the study were analysed (174 in the high-flow nasal oxygen group and 175 in the facemask group). No difference was detected in the number of patients desaturating <93%,five (2.9%) vs. six (3.4%) patients in the high-flow nasal oxygen and facemask group,

respectively (p = 0.77). The risk of desaturation was not increased during on-call hours. No difference was seen in end-tidal carbon dioxide levels in thefirst breath after tracheal intubation or in the number of patients with

signs of regurgitation between groups. These results confirm that high-flow nasal oxygen maintains adequate oxygen levels during pre-oxygenation for rapid sequence induction.

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