High-flow nasal oxygen reduces the incidence of hypoxia in sedated hysteroscopy for assisted reproduction.
High-flow nasal oxygen reduces the incidence of hypoxia in sedated hysteroscopy for assisted reproduction.
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DOI：
10.3389/fmed.2022.929096
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发表时间：
2022
影响因子：
3.9
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中科院分区：
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疼痛是宫腔镜检查失败的主要原因。在日间手术环境中，宫腔镜检查程序通常在患者处于镇静状态下进行。缺氧是镇静过程中最常见的不良事件，可导致严重的不良事件。本研究旨在比较在镇静下接受宫腔镜检查的患者中使用高流量鼻氧（HFNO）与使用常规鼻氧时缺氧的发生率。在这项单中心、前瞻性、随机、单盲研究中，从2021年9月至2021年12月，960例接受择期诊断性或手术性宫腔镜检查的女性患者被随机纳入以下两组：常规鼻内组[O2（3-6 L/min），由HFNO覆盖]和HFNO组[O2（30-60 L/min）]。所有患者均在手术室用丙泊酚（1.5 mg/kg）和瑞芬太尼（1.5 μg/kg）镇静。主要结局为缺氧发生率（75% ≤ SpO 2 <90%，< 60 s）。HFNO可降低缺氧发生率（75% ≤ SpO 2 <90%，< 60 s），亚临床呼吸抑制（90% ≤ SpO 2 < 95%）和严重缺氧SpO 2 < 75%（任何持续时间）或75% ≤ SpO 2 < 90%（≥ 60 s）分别从24.38%、11.25%和3.75%降至0.83%、1.46%和0%（P < 0.001）。在治疗女性不孕症的过程中，HFNO可以减少丙泊酚镇静患者宫腔镜检查期间的缺氧，并可以预防亚临床呼吸抑制和严重缺氧的发生。
Pain is the main reason for hysteroscopy failure. In day-surgical settings, hysteroscopy procedures are commonly performed with the patient under sedation. Hypoxia is the most common adverse event during sedation and can lead to severe adverse events. This study aimed to compare the incidence of hypoxia when using high-flow nasal oxygen (HFNO) with that when using regular nasal oxygen in patients undergoing hysteroscopy with sedation. In this single-center, prospective, randomized, single-blinded study, 960 female patients undergoing elective diagnostic or operative hysteroscopy were randomly enrolled into the following two groups: the regular nasal group [O2 (3–6 L/min) covered by an HFNO] and the HFNO group [O2 (30–60 L/min)] from September 2021 to December 2021. All women were sedated with propofol (1.5 mg/kg) and remifentanil (1.5 μg/kg) in the operating room. The primary outcome was the incidence of hypoxia (75% ≤ SpO2 < 90%, < 60 s). HFNO decreased the incidence of hypoxia (75% ≤ SpO2 < 90%, < 60 s), subclinical respiratory depression (90% ≤ SpO2 < 95%) and severe hypoxia (SpO2 < 75% for any duration or 75% ≤ SpO2 < 90% for ≥ 60 s) from 24.38 to 0.83%, from 11.25 to 1.46% and from 3.75 to 0%, respectively (P < 0.001). In procedures conducted to treat female infertility, HFNO can reduce hypoxia during hysteroscopy in patients sedated with propofol, and it can prevent the occurrence of subclinical respiratory depression and severe hypoxia.