面罩吸氧好还是鼻导管吸氧好？

本文由“小麻哥的日常"授权转载

摘要译文

有低氧血症风险的患者在柔性支气管镜检查中使用高流量鼻导管吸氧或面罩吸氧时氧饱和度降低的发生率：

一项随机对照试验

背景

阻塞性睡眠呼吸暂停（OSA）、男性、肥胖、高龄或高血压患者在柔性支气管镜检查期间容易出现低氧血症。

目的

本研究调查了有低氧血症风险的患者在深度镇静下，使用高流量鼻导管（HFNC）是吸氧否可以降低支气管镜检查中氧饱和度降低的发生率。

方法

共有176名在深度镇静下接受柔性支气管镜检查的低氧血症风险患者被随机分为两组：HFNC组（通过高流量鼻导管以60 L/min的速率和100%的浓度供应湿氧，n = 87）和面罩组（通过紧密贴合的面罩以6L/min的速率和100%的浓度供给氧气，n = 89).

结果

HFNC组4例（4.6%）患者和面罩组26例（29.2%）患者出现氧饱和度降低（P < 0.001)。

面罩组比HFNC组需要更多的托下颌（43 [48.3%]对5[5.7%]，P < 0.001)。 

面罩组有8名患者（9.0%）需要加压面罩通气，HFNC组无一例需要加压口罩通气（P = 0.012).

结论

在深度镇静下的柔性支气管镜检查中，使用HFNC可以降低有低氧血症风险的患者 氧饱和度降低的发生率和气道干预的需求。

原文摘要

Incidence of oxygen desaturation using a high-flow nasal cannula versus a facemask during flexible bronchoscopy in patients at risk of hypoxemia: a randomised controlled trial

Background

Patients with obstructive sleep apnoea (OSA), male sex, obesity, older age or hypertension are prone to hypoxemia during flexible bronchoscopy. This study investigated whether using a high-flow nasal cannula (HFNC) could reduce the incidence of oxygen desaturation during bronchoscopy under deep sedation in patients at risk of hypoxemia.

Methods

A total of 176 patients at risk of hypoxemia who underwent flexible bronchoscopy under deep sedation were randomly assigned to two groups: the HFNC group (humidified oxygen was supplied via a high-flow nasal cannula at a rate of 60 L/min and a concentration of 100%, n = 87) and the facemask group (oxygen was supplied via a tight-fitting facemask at a rate of 6 L/min and a concentration of 100%, n = 89).

Results

Oxygen desaturation occurred in 4 (4.6%) patients in the HFNC group and 26 (29.2%) patients in the facemask group (P < 0.001). The facemask group required more jaw thrust manoeuvres than the HFNC group (43[48.3%] vs. 5[5.7%], P < 0.001). 8 patients (9.0%) in the facemask group and none in the HFNC group required bag-mask ventilation (P = 0.012).

Conclusion

The use of an HFNC can reduce the incidence of oxygen desaturation and the requirement for airway intervention in patients at risk of hypoxemia during flexible bronchoscopy under deep sedation.

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