反特伦德伦伯体位和正压通气对肥胖患者安全非缺氧性呼吸暂停期的影响：一项随机对照试验

以下文章来源于罂粟花 ，作者anesthGH

本文由“罂粟花”授权转载  

反特伦德伦伯体位和正压通气对肥胖患者安全非缺氧性呼吸暂停期的影响：一项随机对照试验

贵州医科大学    麻醉与心脏电生理课题组

翻译：宋雨婷

编辑：宋雨婷

审校：曹莹

目的

在病态肥胖患者的气道管理期间，低氧血症的发生率较高。本研究旨在评估预充氧期间优化体位和通气策略是否允许更长时间的安全非缺氧性呼吸暂停期（SNHAP）。

方法

本研究共纳入五十名病态肥胖患者并随机分为两组。RP/ZEEP组：体位为斜坡位，通气方式为保留患者自主呼吸，无需额外CPAP或PEEP，进行预充氧3分钟；RT/PPV组：体位为反特伦德伦伯体位，通气方式为保留自主呼吸的压力支持通气模式，吸入气压力为8cmH2O ，呼气末正压为10 cmH2O，进行预充氧3分钟。

结果

RT/PPV组的SNHAP明显更长（258.2（55.1）比216.7（42.3）秒，P = 0.005）。RT/PPV组在更短时间内呼气末氧浓度（FEtO2） 达到0.90（85.1（47.8）比145.3（40.8）秒，P < 0.0001），FEtO2达到0.90的患者比例更高20.90（21/24，88%比13/24，54%，P = 0.024），预充氧期间FEtO2 更高（0.91（0.05）比0.89（0.01），P = 0.003），恢复通气后氧饱和度能更快恢复至97%（69.8（24.2）比91.4（39.2）秒，P = 0.038）。

结论

在病态肥胖人群中，与RP/ZEEP相比，RT/PPV延长了SNHAP，减少了达到最佳预充氧状态的时间，且能更快地恢复至安全氧饱和度。RT/PPV为气管插管留出更长的时间，并将高危人群的低氧血症风险降至更低。

原始文献来源

Couture, E.J., Carrier-Boucher, A., Provencher, S. et al. Effect of reverse Trendelenburg position and positive pressure ventilation on safe non-hypoxic apnea period in obese, a randomized-control trial. BMC Anesthesiol 23, 198 (2023). 

英文原文

Effect of reverse Trendelenburg position and positive pressure ventilation on safe non-hypoxic apnea period in obese, a randomized-control trial

Purpose: There is an elevated incidence of hypoxemia during the airway management of the morbidly obese. We aimed to assess whether optimizing body position and ventilation during pre-oxygenation allow a longer safe non-hypoxic apnea period (SNHAP).

Methods: Fifty morbidly obese patients were recruited and randomized for this study. Patients were positioned and preoxygenated for three minutes in the ramp position associated with spontaneous breathing without additional CPAP or PEEP (RP/ZEEP group) or in the reverse Trendelenburg position associated with pressure support ventilation mode with pressure support of 8 cmH2O and an additional 10 cmH2O of PEEP while breathing spontaneously (RT/PPV group) according to randomization.

Results: The SNHAP was significantly longer in the RT/PPV group (258.2 (55.1) vs. 216.7 (42.3) seconds, p = 0.005). The RT/PPV group was also associated to a shorter time to obtain a fractional end-tidal oxygen concentration (FEtO2) of 0.90 (85.1(47.8) vs 145.3(40.8) seconds, p < 0.0001), a higher proportion of patients that reached the satisfactory FEtO2 of 0.90 (21/24, 88% vs. 13/24, 54%, p = 0.024), a higher FEtO2 during preoxygenation (0.91(0.05) vs. 0.89(0.01), p = 0.003) and a faster return to 97% oxygen saturation after ventilation resumption (69.8 (24.2) vs. 91.4 (39.2) seconds, p = 0.038).

Conclusion: In the morbidly obese population, RT/PPV, compared to RP/ZEEP, lengthens the SNHAP, decreases the time to obtain optimal preoxygenation conditions, and allows a faster resuming of secure oxygen saturation. The former combination allows a more significant margin of time for endotracheal intubation and minimizes the risk of hypoxemia in this highly vulnerable population.

-End-

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编辑：Michel.米萱

校对：MiLu.米鹭

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