不同流速快充式经鼻湿化高流量通气在无痛胃镜检查中预防低氧血症的效果比较

Comparison of different flow rates of transnasal humidified rapid‑insufflation ventilatory exchange for prevention of hypoxemia in painless gastroscopy

摘要:

目的 探讨不同流速快充式经鼻湿化高流量通气（transnasal humidified rapid‑insufflation ventilatory exchange，Thrive）对无痛胃镜检查患者缺氧不良事件的影响。方法 选择2020年4—7月在南京市第一医院行无痛胃镜检查的患者作为研究对象，采用随机数字表法将患者随机分配至Thrive流速30 L/min组（n=52）、50 L/min组（n=55）和70 L/min组（n=54）3组。主要观察3组患者胃镜检查过程中不同程度缺氧事件，包括亚临床呼吸抑制、缺氧和严重缺氧的发生率及其他不良事件发生率。结果 70 L/min组患者的缺氧不良事件总发生率为0（0/54），明显低于30 L/min组（21.3%，11/52）和50 L/min组（12.7%，7/55）（χ2=12.75，P<0.001；P=0.007）。30 L/min组和50 L/min组亚临床呼吸抑制［13.5%（7/52）比5.5%（3/55），χ2=1.19，P=0.194］和缺氧［7.7%（4/52）比7.3%（4/55），P=0.610］的发生率差异无统计学意义。3组患者均未发生严重缺氧。30 L/min组和50 L/min组出现低氧血症的患者通过托下颌开放气道后，氧合均得到改善（SpO2>95%）。此外3组患者除低氧血症外的其他不良事件发生率差异无统计学意义（P>0.05）。结论 30 L/min、50 L/min、70 L/min流速的Thrive可预防患者无痛胃镜检查时严重缺氧事件的发生，并且70 L/min的流速可进一步降低患者亚临床呼吸抑制发生率。

Abstract:

Objective To explore the clinical effect of different flow rates of transnasal humidified rapid-insufflation ventilatory exchange (Thrive) on hypoxic events during painless gastroscopy. Methods Patients who underwent painless gastroscopy in Nanjing First Hospital from April to July 2020 were randomly selected by random number table method and assigned to Thrive groups of 30 L/min (n=52), 50 L/min (n=55) and 70 L/min (n=54). The incidences of different degree of hypoxic events (including subclinical respiratory depression, hypoxia and severe hypoxia) and adverse events related to Thrive were recorded. Results The total incidence of hypoxic events in the 70 L/min group was 0 (0/54), which was significantly lower than that in the 30 L/min group (21.3%, 11/52, χ2=12.75, P<0.001) and 50 L/min group (12.7%, 7/55, P=0.007). There were no significant differences in subclinical respiratory depression [13.5% (7/52) VS 5.5% (3/55), χ2=1.19, P=0.194] or hypoxia [7.7% (4/52) VS 7.3% (4/55), P=0.610] between 30 L/min group and 50 L/min group. No severe hypoxia occurred in any group. The oxygenation of patients with hypoxemia in 30 L/min and 50 L/min groups was improved (SpO2>95%) after opening the airway by mandibular support. In addition, there were no significant differences in the incidence of adverse events except hypoxemia among the three groups (P>0.05). Conclusion The flow rates of Thrive of 30 L/min, 50 L/min, and 70 L/min can prevent the occurrence of severe hypoxia during painless gastroscopy, and the flow rate of 70 L/min can further reduce the incidence of subclinical respiratory depression.