【罂粟摘要】上半身抬高与高流量鼻插管联合治疗术后睡眠呼吸障碍：随机交叉试验

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上半身抬高与高流量鼻插管联合治疗术后睡眠呼吸障碍：随机交叉试验

贵州医科大学    麻醉与心脏电生理课题组

翻译：胡廷菊

编辑：柏雪

审校：曹莹

背景：

未经治疗的阻塞性睡眠呼吸暂停（OSA）患者术后持续气道正压治疗的接受率较低，提示探索可替代的术后气道管理策略的必要性。作者提出高流量鼻插管联合上半身抬高是否能改善术后OSA。

方法：

这项非盲随机交叉研究在一家大学医院进行，在术后第一和第二个晚上，23名符合条件的参与者随机分配到高流量鼻插管联合床头抬高组或不抬高30度组。调查了对于中到重度阻塞性睡眠呼吸暂停患者有无上半身抬高对改良呼吸暂停低通气指数的影响，即完全基于气流信号，而无动脉血氧饱和度标准（基于流量的呼吸暂停低通气指数，主要观察指标）的高流量鼻插管（20 l/min,40%氧浓度）的影响。术前的睡眠研究分别在家（对照组，无床头抬高）和在医院（床头抬高30度）进行。

结果：

23例患者中有22例（96%）接受了高流量鼻插管。四名受试者退出了这项研究。对于仅床头抬高（95% CI，6至30），基于流量的呼吸暂停低通气指数（平均± SD，60 ± 12次/小时；n = 19)降低了15次/小时（P=0.002）；对于仅高流量鼻插管（95% CI，1至21），基于流量的呼吸暂停低通气指数降低10.9次/小时（P = 0.028）；床头抬高联合高流量鼻插管（95% CI，13至32）基于流量的呼吸暂停低通气指数降低23次/小时（P < 0.001）。与单纯高流量鼻插管相比，床头抬高干预显著降低了基于流量的呼吸暂停低通气指数12次/小时（95%CI，2至21；P = 0.022)。高流量鼻插管，单独或联合床头抬高，也改善了整个夜间氧合。未观察到任何不良事件。

结论：

高流量鼻插管和上半身抬高的联合治疗降低了OSA的严重程度和夜间低氧血症，提示其作为替代术后气道管理策略的重要作用。

原始文献来源：

Yuichi Sakaguchi, Natsuko Nozaki-Taguchi, Makoto Hasegawa, et, al.  Combination Therapy of High-flow Nasal Cannulaand Upper-body Elevation for Postoperative Sleep-disordered Breathing: Randomized Crossover Trial. Anesthesiology 2022; 137:15–27

英文原文：

Combination Therapy of High-flow Nasal Cannulaand Upper-body Elevation for Postoperative Sleep-disordered Breathing: Randomized Crossover Trial

Abstract

Background:: The low acceptance rate of continuous positive airway pressure therapy in postoperative patients with untreated obstructive sleep apnea (OSA) indicates the necessity for development of an alternative postoperative airway management strategy. The authors considered whether the combination of high-flow nasal cannula and upper-body elevation could improve postoperative OSA.

Methods: This nonblinded randomized crossover study performed at a single university hospital investigated the effect on a modified apnea hypopnea index, based exclusively on the airflow signal without arterial oxygen saturation criteria (flow-based apnea hypopnea index, primary outcome), of high-flow nasal cannula (20 l · min–1 with 40% oxygen concentration) with and without upper-body elevation in patients with moderate to severe OSA. Preoperative sleep studies were performed at home (control, no head-of-bed elevation) and in hospital (30-degree head-of-bed elevation). On the first and second postoperative nights, high-flow nasal cannula was applied with or without 30-degree head-of-bed elevation, assigned in random order to 23 eligible participants.

Results: Twenty-two of the 23 (96%) accepted high-flow nasal cannula. Four participants resigned from the study. Control flow-based apnea hypopnea index (mean ± SD, 60 ± 12 events · h–1; n = 19) was reduced by 15 (95% CI, 6 to 30) events · h–1 with head-of-bed elevation alone (P = 0.002), 10.9 (95% CI, 1 to 21) events · h–1 with high-flow nasal cannula alone (P = 0.028), and 23 (95% CI, 13 to 32) events · h–1 with combined head-of-bed elevation and high-flow nasal cannula (P < 0.001). Compared to sole high-flow nasal cannula, additional intervention with head-of-bed elevation significantly decreased flow-based apnea hypopnea index by 12 events · h–1 (95% CI, 2 to 21; P = 0.022). High-flow nasal cannula, alone or in combination with headof-bed elevation, also improved overnight oxygenation. No harmful events were observed.

Conclusions:The combination of high-flow nasal cannula and upper-body

elevation reduced OSA severity and nocturnal hypoxemia, suggesting a role

for it as an alternate postoperative airway management strategy.

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