Nasopharyngeal Tube Effects on Breathing during Sedation for Dental Procedures: A Randomized Controlled Trial.
Nasopharyngeal Tube Effects on Breathing during Sedation for Dental Procedures: A Randomized Controlled Trial.
复制标题
牙科手术镇静期间鼻咽管对呼吸的影响：随机对照试验。
DOI：
10.1097/aln.0000000000002661
复制
发表时间：
2019
期刊：
影响因子：
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通讯作者：
Iijima T.
中科院分区：
文献类型：
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作者：
Kohzuka Y;Isono S;Ohara S;Kawabata K;Kitamura A;Suzuki T;Almeida FR;Sato Y;Iijima T.
背景静脉镇静对于接受牙科手术的患者是有效的，但已记录了致命的低氧血症事件。据推测，异常呼吸事件频繁发生，并且在牙科手术镇静期间脉搏血氧饱和度检测不足（主要假设），而插入小直径鼻咽管可降低异常呼吸事件的频率（次要假设）。 方法在这项非盲随机对照研究中，确定了牙科手术镇静患者每小时异常呼吸发作的频率（异常呼吸指数），并将其用作检验假设的主要结果。通过便携式睡眠监测仪测量异常呼吸指数。 46 名参与者中，43 名被随机分配到对照组（n=23，无鼻咽管）和鼻咽管组（n=20）。 结果对照组中，非去饱和异常呼吸指数高于去饱和异常呼吸指数（35.2 [20.6, 48.0] vs. 7.2 [4.1, 18.5] h，差异：25.1 [95% CI，13.8 至 36.4]，P<0.001）。阻塞性呼吸异常指数大于中枢性呼吸异常指数（P<0.001），且一半异常呼吸指数继发不规则呼吸。尽管存在异常呼吸的阻塞性质，但鼻咽管并没有显着降低异常呼吸指数（48.0 [33.8, 64.4] h vs. 50.5 [36.4, 63.9] h，差异：-2.0 [95% CI，-15.2 to 11.2]，P= 0.846），不支持次要假设。结论 牙科镇静患者手术过程中经常会遇到阻塞性呼吸暂停/呼吸不足事件。大多数阻塞性呼吸暂停/呼吸不足事件无法通过脉搏血氧饱和度检测到。小直径鼻咽管缓解事件的效果有限。
BackgroundIntravenous sedation is effective in patients undergoing dental procedures, but fatal hypoxemic events have been documented. It was hypothesized that abnormal breathing events occur frequently and are underdetected by pulse oximetry during sedation for dental procedures (primary hypothesis) and that insertion of a small-diameter nasopharyngeal tube reduces the frequency of the abnormal breathing events (secondary hypothesis).MethodsIn this nonblinded randomized control study, frequency of abnormal breathing episodes per hour (abnormal breathing index) of the patients under sedation for dental procedures was determined and used as a primary outcome to test the hypotheses. Abnormal breathing indexes were measured by a portable sleep monitor. Of the 46 participants, 43 were randomly allocated to the control group (n= 23, no nasopharyngeal tube) and the nasopharyngeal tube group (n= 20).ResultsIn the control group, nondesaturated abnormal breathing index was higher than the desaturated abnormal breathing index (35.2 [20.6, 48.0] vs. 7.2 [4.1, 18.5] h, difference: 25.1 [95% CI, 13.8 to 36.4], P< 0.001). The obstructive abnormal breathing index was greater than central abnormal breathing index (P< 0.001), and half of abnormal breathing indexes were followed by irregular breathing. Despite the obstructive nature of abnormal breathing, the nasopharyngeal tube did not significantly reduce the abnormal breathing index (48.0 [33.8, 64.4] h vs. 50.5 [36.4, 63.9] h, difference:-2.0 [95% CI,-15.2 to 11.2], P= 0.846), not supporting the secondary hypothesis.ConclusionsPatients under sedation for dental procedure frequently encounter obstructive apnea/hypopnea events. The majority of the obstructive apnea/hypopnea events were not detectable by pulse oximetry. The effectiveness of a small-diameter nasopharyngeal tube to mitigate the events is limited.