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Anesthesia & Analgesia:术中高流量鼻氧的有效性:一项系统回顾和Meta分析

2021-06-30 “罂粟花”公众号 “罂粟花”公众号

高流量鼻氧(HFNO)越来越多地用于重症监护病房的低氧血症和呼吸衰竭患者的管理。然而,高流量鼻导管氧疗预防术中低氧血症的效果尚不明确。

背景

高流量鼻氧(HFNO)越来越多地用于重症监护病房的低氧血症和呼吸衰竭患者的管理。然而,高流量鼻导管氧疗预防术中低氧血症的效果尚不明确。本系统回顾的目的是比较手术患者术中HFNO与常规氧合的患者氧合和呼气末CO2 (ETCO2)。

方法

我们检索了直至2020年2月标准数据库内的文献。研究包括术中使用高流量鼻导管氧疗的4种结果中的1种:(1)氧(O2)饱和度降低,(2)最低O2饱和度,(3)安全呼吸暂停时间,或(4)ETCO2。术中分为2个阶段:全麻诱导期和镇静下无气管插管手术期。

结果

八项随机对照试验(RCT;4项诱导,4项程序,共2314例患者)被纳入系统回顾和Meta分析。我们发现HFNO与传统氧合对照组相比,术中氧饱和度降低的风险较低;诱导时的优势比(OR;95%置信区间[CI])为0.06(0.01-0.59,P =0 .02),手术期间OR(95% CI)为0.09(0.05-0.18;P <0 . 001)。与传统氧合相比,HFNO 的最低 O2 饱和度更高;诱导时的平均差(MD) (95% CI)为5.1% (3.3–6.9; P<0 .001),在手术过程中,MD (95% CI)为4.0% (1.8-6.2; P <0.001)。与常规氧合相比,HFNO诱导时允许的安全呼吸暂停时间更长,MD(95% CI)为33.4秒(16.8-50.1;P <0.001)。HFNO组和常规氧合组在诱导时的ETCO2没有显着差异。

结论

这项系统回顾和Meta分析显示,在术中,HFNO与传统氧合相比,降低了O2去饱和的风险,增加了最低O2饱和度和允许安全呼吸暂停时间。对于低氧血症风险较高的患者,在麻醉诱导和手术过程中,应考虑在镇静下不经气管插管的情况下使用HFNO。

原始出处:

Spence E A , Rajaleelan W , J Wong, et al. The Effectiveness of High-Flow Nasal Oxygen During the Intraoperative Period: A Systematic Review and Meta-analysis[J]. Anesthesia & Analgesia, 2020, 131.

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createdName=xiangyuzhou971, createdTime=Thu May 26 00:25:19 CST 2022, time=2022-05-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1956568, encodeId=207c19565682c, content=<a href='/topic/show?id=9559e976b0' target=_blank style='color:#2F92EE;'>#GES#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7976, encryptionId=9559e976b0, topicName=GES)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4b632500090, createdName=h.y200607_23674418, createdTime=Sat Apr 23 01:25:19 CST 2022, time=2022-04-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1700126, encodeId=e0481e0012636, content=<a href='/topic/show?id=295524e541' target=_blank style='color:#2F92EE;'>#Anal#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2475, encryptionId=295524e541, topicName=Anal)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=de3a29999500, createdName=经常头晕, createdTime=Mon Jul 19 22:25:19 CST 2021, time=2021-07-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1888314, encodeId=7c4c1888314fc, content=<a href='/topic/show?id=d56611584ec' target=_blank style='color:#2F92EE;'>#Meta#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11584, encryptionId=d56611584ec, topicName=Meta)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d8f4110, createdName=guojianrong, createdTime=Tue Sep 14 00:25:19 CST 2021, time=2021-09-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1633604, encodeId=d1fd163360418, content=<a href='/topic/show?id=377824e1c0' target=_blank style='color:#2F92EE;'>#ANA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2471, encryptionId=377824e1c0, topicName=ANA)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=434d22047430, createdName=AspirantSuo, createdTime=Sun Jan 09 09:25:19 CST 2022, time=2022-01-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1779906, encodeId=02331e79906d6, content=<a href='/topic/show?id=f89b25041c' target=_blank style='color:#2F92EE;'>#anesthesia#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2504, encryptionId=f89b25041c, topicName=anesthesia)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7931272, createdName=liuli5079, createdTime=Wed Jun 30 21:25:19 CST 2021, time=2021-06-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1539236, encodeId=a20c153923603, content=<a href='/topic/show?id=6505108534a' target=_blank style='color:#2F92EE;'>#lgE#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10853, encryptionId=6505108534a, topicName=lgE)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=beb613117181, createdName=HNYYM, createdTime=Fri Jul 02 07:25:19 CST 2021, time=2021-07-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1576425, encodeId=c72315e64252c, content=<a href='/topic/show?id=e02ee6901a2' target=_blank style='color:#2F92EE;'>#系统回顾#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=93, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76901, encryptionId=e02ee6901a2, topicName=系统回顾)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=27e316318097, createdName=ms5822920152752585, createdTime=Fri Jul 02 07:25:19 CST 2021, time=2021-07-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1588471, encodeId=176e15884e1d9, content=<a href='/topic/show?id=1cb8e014e0' target=_blank style='color:#2F92EE;'>#ESI#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7014, encryptionId=1cb8e014e0, topicName=ESI)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f4f817593223, createdName=skhzy, createdTime=Fri Jul 02 07:25:19 CST 2021, time=2021-07-02, status=1, ipAttribution=)]
    2021-07-19 经常头晕
  5. [GetPortalCommentsPageByObjectIdResponse(id=1896863, encodeId=480c18968639c, content=<a href='/topic/show?id=4a391158248' target=_blank style='color:#2F92EE;'>#MET#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11582, encryptionId=4a391158248, topicName=MET)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=18fc139, createdName=一闲, createdTime=Thu Jul 08 08:25:19 CST 2021, time=2021-07-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2051668, encodeId=aa362051668d6, content=<a href='/topic/show?id=95f8e042dd' target=_blank style='color:#2F92EE;'>#EST#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7042, encryptionId=95f8e042dd, topicName=EST)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e9a6357, 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channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2471, encryptionId=377824e1c0, topicName=ANA)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=434d22047430, createdName=AspirantSuo, createdTime=Sun Jan 09 09:25:19 CST 2022, time=2022-01-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1779906, encodeId=02331e79906d6, content=<a href='/topic/show?id=f89b25041c' target=_blank style='color:#2F92EE;'>#anesthesia#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2504, encryptionId=f89b25041c, topicName=anesthesia)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7931272, createdName=liuli5079, createdTime=Wed Jun 30 21:25:19 CST 2021, time=2021-06-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1539236, encodeId=a20c153923603, content=<a href='/topic/show?id=6505108534a' target=_blank style='color:#2F92EE;'>#lgE#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10853, encryptionId=6505108534a, topicName=lgE)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=beb613117181, createdName=HNYYM, createdTime=Fri Jul 02 07:25:19 CST 2021, time=2021-07-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1576425, encodeId=c72315e64252c, content=<a href='/topic/show?id=e02ee6901a2' target=_blank style='color:#2F92EE;'>#系统回顾#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=93, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76901, encryptionId=e02ee6901a2, topicName=系统回顾)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=27e316318097, createdName=ms5822920152752585, createdTime=Fri Jul 02 07:25:19 CST 2021, time=2021-07-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1588471, encodeId=176e15884e1d9, content=<a href='/topic/show?id=1cb8e014e0' target=_blank style='color:#2F92EE;'>#ESI#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7014, encryptionId=1cb8e014e0, topicName=ESI)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f4f817593223, createdName=skhzy, createdTime=Fri Jul 02 07:25:19 CST 2021, time=2021-07-02, status=1, ipAttribution=)]
    2021-09-14 guojianrong
  6. [GetPortalCommentsPageByObjectIdResponse(id=1896863, encodeId=480c18968639c, content=<a href='/topic/show?id=4a391158248' target=_blank style='color:#2F92EE;'>#MET#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11582, encryptionId=4a391158248, topicName=MET)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=18fc139, createdName=一闲, createdTime=Thu Jul 08 08:25:19 CST 2021, time=2021-07-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2051668, encodeId=aa362051668d6, content=<a href='/topic/show?id=95f8e042dd' target=_blank style='color:#2F92EE;'>#EST#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7042, encryptionId=95f8e042dd, topicName=EST)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e9a6357, 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content=<a href='/topic/show?id=6505108534a' target=_blank style='color:#2F92EE;'>#lgE#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10853, encryptionId=6505108534a, topicName=lgE)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=beb613117181, createdName=HNYYM, createdTime=Fri Jul 02 07:25:19 CST 2021, time=2021-07-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1576425, encodeId=c72315e64252c, content=<a href='/topic/show?id=e02ee6901a2' target=_blank style='color:#2F92EE;'>#系统回顾#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=93, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76901, encryptionId=e02ee6901a2, topicName=系统回顾)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=27e316318097, createdName=ms5822920152752585, createdTime=Fri Jul 02 07:25:19 CST 2021, time=2021-07-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1588471, encodeId=176e15884e1d9, content=<a href='/topic/show?id=1cb8e014e0' target=_blank style='color:#2F92EE;'>#ESI#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7014, encryptionId=1cb8e014e0, topicName=ESI)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f4f817593223, createdName=skhzy, createdTime=Fri Jul 02 07:25:19 CST 2021, time=2021-07-02, status=1, ipAttribution=)]
    2022-01-09 AspirantSuo
  7. 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2021, time=2021-07-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1588471, encodeId=176e15884e1d9, content=<a href='/topic/show?id=1cb8e014e0' target=_blank style='color:#2F92EE;'>#ESI#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7014, encryptionId=1cb8e014e0, topicName=ESI)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f4f817593223, createdName=skhzy, createdTime=Fri Jul 02 07:25:19 CST 2021, time=2021-07-02, status=1, ipAttribution=)]
  8. [GetPortalCommentsPageByObjectIdResponse(id=1896863, encodeId=480c18968639c, content=<a href='/topic/show?id=4a391158248' target=_blank style='color:#2F92EE;'>#MET#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11582, encryptionId=4a391158248, topicName=MET)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=18fc139, createdName=一闲, createdTime=Thu Jul 08 08:25:19 CST 2021, time=2021-07-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2051668, encodeId=aa362051668d6, content=<a href='/topic/show?id=95f8e042dd' target=_blank style='color:#2F92EE;'>#EST#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7042, encryptionId=95f8e042dd, topicName=EST)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e9a6357, 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content=<a href='/topic/show?id=6505108534a' target=_blank style='color:#2F92EE;'>#lgE#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10853, encryptionId=6505108534a, topicName=lgE)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=beb613117181, createdName=HNYYM, createdTime=Fri Jul 02 07:25:19 CST 2021, time=2021-07-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1576425, encodeId=c72315e64252c, content=<a href='/topic/show?id=e02ee6901a2' target=_blank style='color:#2F92EE;'>#系统回顾#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=93, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76901, encryptionId=e02ee6901a2, topicName=系统回顾)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=27e316318097, createdName=ms5822920152752585, createdTime=Fri Jul 02 07:25:19 CST 2021, time=2021-07-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1588471, encodeId=176e15884e1d9, content=<a href='/topic/show?id=1cb8e014e0' target=_blank style='color:#2F92EE;'>#ESI#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7014, encryptionId=1cb8e014e0, topicName=ESI)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f4f817593223, createdName=skhzy, createdTime=Fri Jul 02 07:25:19 CST 2021, time=2021-07-02, status=1, ipAttribution=)]
    2021-07-02 HNYYM
  9. 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  10. 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    2021-07-02 skhzy

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