【罂粟摘要】低氧血症高危风险患者应用双水平气道正压行镇静下胃镜检查：一项前瞻性随机对照研究

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低氧血症高危风险患者应用双水平气道正压行镇静下胃镜检查：一项前瞻性随机对照研究

贵州医科大学    麻醉与心脏电生理课题组

翻译：佟睿  编辑：张中伟  审校：曹莹

研究目的：低氧血症是胃镜检查的镇静过程中最常见的不良反应之一，目前尚无有效的预防方法。因此，我们进行了这项随机试验，以证实我们的假设，即：与鼻插管组相比，双水平气道正压(BPAP)可以降低阻塞性睡眠呼吸暂停(OSA)或超重患者在镇静下接受胃镜检查时低氧血症的发生率。

研究设计：在这项单中心、前瞻性、随机对照的临床试验中，共纳入了80名年龄18-65岁在镇静下接受胃镜检查的OSA或超重患者，并被随机分为两组：鼻插管组和BPAP组。主要观察指标是低氧血症的发生率(75%<外周血氧饱和度[SpO2]<90% 超过5s且小于60s)。

主要结果：与鼻插管组比较，BPAP组的低氧血症发生率从40.0%降至2.5%(绝对风险差37.5%，[95%可信区间=21.6-53.4]，P<0.001)，亚临床呼吸抑制发生率从52.5%降至22.5%(鼻插管组为30.0%，[95%可信区间=9.8-50.2]，P=0.006)，重度低氧血症发生率从17.5%降至0%(P<0.05)。17.5%[95%CI，5.7-29.3]，P=0.006。BPAP干预还减少了丙泊酚的总用量和手术时间，提高了麻醉医生的满意度。

结论：BPAP治疗显著降低了在镇静下接受胃镜检查的OSA或超重患者的低氧血症发生率。

原始文献来源：Shuailei Wang, Ning Shen, Yanling Wang , et al. Bilevel positive airway pressure for gastroscopy with sedation in patients at risk of hypoxemia: A prospective randomized controlled study.[J]Journal of Clinical Anesthesia 85 (2023) 111042.

英文原文     

Bilevel positive airway pressure for gastroscopy with sedation in patients at risk of hypoxemia: A prospective randomized controlled study

Abstract

Study objective: Hypoxemia is one of the most frequent adverse events during sedated gastroscopy, and there is still no effective means to prevent and cure it. Therefore, we conducted this randomized trial to confirm our hypothesis that, compared with the nasal cannula group, bilevel positive airway pressure (BPAP) would decrease the incidence of hypoxemia in patients with obstructive sleep apnea (OSA) or overweight status undergoing gastroscopy.

Design: In a single-center, prospective, randomized controlled clinical trial, 80 patients aged 18–65 years and with OSA or overweight status who underwent gastroscopy with sedation were randomly assigned to two groups: the nasal cannula and BPAP groups. The primary outcome was the incidence of hypoxemia (75% < peripheral oxygen saturation [SpO2] < 90% for >5s and <60s).

Main results: Compared to the nasal cannula group, BPAP therapy significantly decreased the incidence of hypoxemia from 40.0% to 2.5% (absolute risk difference [ARD], 37.5% [95% confidence interval (CI), 21.6 to 53.4], p < 0.001), decreased subclinical respiratory depression from 52.5% to 22.5% (ARD, 30.0% [95% CI, 9.8 to 50.2], p = 0.006), and decreased severe hypoxemia from 17.5% to 0% (ARD, 17.5% [95% CI, 5.7 to 29.3], p = 0.006). The BPAP intervention also decreased the total propofol dosage and operation time and improved anesthesiologist’s satisfaction.

Conclusion: BPAP therapy significantly decreased the incidence of hypoxemia in patients with OSA or overweight status who underwent gastroscopy.

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