【罂粟摘要】高流量鼻氧与标准面罩氧合对麻醉诱导期间预充氧和窒息氧合的有效性比较：一项系统评价和Meta分析

高流量鼻氧与标准面罩氧合对麻醉诱导期间预充氧和窒息氧合的有效性比较：一项系统评价和Meta分析

贵州医科大学    麻醉与心脏电生理课题组

翻译：柏雪  编辑：张中伟  审校：曹莹

研究目的：高流量鼻氧（HFNO）已广泛应用于临床，尤其是在围手术期。许多研究讨论了 HFNO 在预充氧和窒息氧合中的作用，但其结果存在争议。我们的研究旨在通过相关随机对照试验 (RCT）的Meta分析来验证 HFNO 在预充氧和窒息氧合中的有效性。

研究方法：我们对从研究开始到 2021年7月内EMBASE、PUBMED 和 COCHRANE 图书馆数据库的文献进行了搜索，以获取有关 HFNO 与标准面罩通气 (FMV) 在预充氧和窒息氧合中的有效性的RCT。涉及以下六项指标之一的研究：（1）动脉血氧分压（PaO2），（2）呼气末氧浓度（EtO2），（3）安全呼吸暂停时间，（4）最低脉搏血氧饱和度（SpO2min），（5）氧合（O2）去饱和，(6)包括呼气末二氧化碳(EtCO2)或动脉二氧化碳分压(PaCO2)。由于本研究观察指标临床异质性的来源，我们采用随机效应模型进行分析，将其表示为均差（MD）或风险比（RR），置信区间为95%（95% CI)。我们对符合条件的研究进行了偏倚风险评估，并评估了每个结果的整体证据质量。

主要结果：最终纳入了 14 项 RCT 和 1012 名参与者。我们发现 HFNO 组的 PaO2 高于 FMV 组，预氧合后的 MD（95% CI）为 57.38 mmHg（25.65 至 89.10；p = 0.0004），并且安全呼吸暂停时间显着延长，麻醉诱导期间的MD（95% CI）为 86.93 秒（44.35至129.51；p < 0.0001）。两组麻醉诱导期间最小SpO2、CO2蓄积、EtO2和O2去饱和率差异无统计学意义。

结论：该系统评价和Meta分析表明，HFNO 应被视为麻醉诱导期间患者的氧合工具。与 FMV 相比，麻醉诱导期间持续使用 HFNO 可显着改善手术患者的氧合并延长安全呼吸暂停时间。

原始文献来源：Jian-Li Song , Yan Sun , Yu-Bo Shi , et, al. Comparison of the effectiveness of high-flow nasal oxygen vs. standard facemask oxygenation for pre- and apneic oxygenation during anesthesia induction: a systematic review and meta-analysis. Song et al BMC Anesthesiology (2022) 22:100.

英文原文     

Comparison of the effectiveness of high-flow nasal oxygen vs. standard facemask oxygenation for pre- and apneic oxygenation during anesthesia induction: a systematic review and meta-analysis

Abstract

Background: In recent years, high flow nasal oxygen (HFNO) has been widely used in clinic, especially in periopera tive period. Many studies have discussed the role of HFNO in pre and apneic oxygenation, but their results are con troversial. Our study aimed to examine the effectiveness of HFNO in pre and apneic oxygenation by a metaanalysis of RCTs.

Methods: EMBASE, PUBMED, and COCHRANE LIBRARY databases were searched from inception to July 2021 for relevant randomized controlled trails (RCTs) on the effectiveness of HFNO versus standard facemask ventilation (FMV) in pre- and apenic oxygenation. Studies involving one of the following six indicators: (1) Arterial oxygen partial pressure (PaO2), (2) End expiratory oxygen concentration (EtO2), (3) Safe apnoea time, (4) Minimum pulse oxygen saturation (SpO2min), (5) Oxygenation (O2) desaturation, (6) End expiratory carbon dioxide (EtCO2) or Arterial carbon dioxide partial pressure(PaCO2) were included. Due to the source of clinical heterogeneity in the observed indicators in this study, we adopt random-effects model for analysis, and express it as the mean difference (MD) or risk ratio (RR) with a confidence interval of 95% (95%CI). We conducted a risk assessment of bias for eligible studies and assessed the overall quality of evidence for each outcome.

Results: Fourteen RCTs and 1012 participants were finally included. We found the PaO2 was higher in HFNO group than FMV group with a MD (95% CI) of 57.38 mmHg (25.65 to 89.10; p=0.0004) after preoxygenation and the safe apnoea time was significantly longer with a MD (95% CI) of 86.93 s (44.35 to 129.51; p< 0.0001) during anesthesia induction. There were no significant statistical difference in the minimum SpO2, CO2 accumulation, EtO2 and O2 desaturation rate during anesthesia induction between the two groups.

Conclusions: This systematic review and meta-analysis suggests that HFNO should be considered as an oxygenation tool for patients during anesthesia induction. Compared with FMV, continuous use of HFNO during anesthesia induction can significantly improve oxygenation and prolong safe apnoea time in surgical patients.

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