经鼻高流量呼吸支持减少内镜逆行胰胆管造影术中的阿片类药物需求
Respiratory Support With Nasal High Flow Reduces Opioid Requirements During Endoscopic Retrograde Cholangiopancreatography.
摘要(中文译文)
经鼻高流量（NHF）可改善氧合、降低呼吸做功并稳定通气。在右美托咪定为基础镇静的内镜逆行胰胆管造影术（ERCP）中，常需使用阿片类药物，但会增加呼吸抑制和恢复延迟的风险。本研究检验了以下假设：与低流量吸氧（LFO）相比，NHF治疗可减少ERCP期间的阿片类药物需求量。这项开放标签、单中心、随机对照试验纳入了在右美托咪定为基础镇静下接受ERCP的患者。患者被随机分配至NHF组或LFO组。镇静采用右美托咪定、咪达唑仑和哌替啶，并遵循标准化方案。主要终点为哌替啶总剂量。次要终点包括经皮二氧化碳（TcCO）、氧合-灌注参数、处理脑电图（EEG）参数、镇静剂剂量及镇静深度。由于招募缓慢，研究在入组94例患者（计划118例）后提前终止（NHF组47例，LFO组47例）。泊松回归显示NHF组阿片类药物需求量减少（发病率比0.77，95%置信区间0.62-0.96，= 0.023）。NHF组哌替啶总剂量较低（中位数43.75 mg vs. 70.00 mg，= 0.004）。两组间TcCO及氧合-灌注参数相当。EEG检测显示NHF组患者状态指数和肌电活动较低，表明镇静更深。未观察到与干预相关的不良事件。NHF在ERCP期间减少了阿片类药物需求量，同时维持了氧合、通气和镇静。NHF能够提供呼吸支持、确保充分氧合并允许监测呼吸，使其成为程序化镇静中一种有前景的模式；然而，仍需进一步的多中心研究。072210047 [jRCTs]。
Abstract
Nasal high flow (NHF) improves oxygenation, reduces the work of breathing, and stabilizes ventilation. In endoscopic retrograde cholangiopancreatography (ERCP) under dexmedetomidine-based sedation, opioids are often required but increase the risk of respiratory depression and delayed recovery. This study tested the hypothesis that NHF therapy, compared with low-flow oxygen (LFO), may reduce opioid requirements during ERCP. This open-label, single-center, randomized controlled trial enrolled patients undergoing ERCP under dexmedetomidine-based sedation. Patients were randomized to NHF or LFO. Sedation used dexmedetomidine, midazolam and pethidine with a standardized protocol. The primary endpoint was total pethidine dose. Secondary endpoints included transcutaneous carbon dioxide (TcCO), oxygenation-perfusion parameters, processed electroencephalography (EEG) parameters, sedative doses, and sedation depth. Enrollment ended early at a total of 94 of the planned 118 patients due to slow recruitment (NHF 47, LFO 47). Poisson regression demonstrated reduced opioid requirements with NHF (incidence rate ratio 0.77, 95% confidence interval, 0.62-0.96, = 0.023). The total pethidine dose was lower in the NHF group (medians 43.75 mg vs. 70.00 mg, = 0.004). The TcCO and oxygenation-perfusion parameters were comparable between groups. EEG tests showed lower patient state index and electromyographic activity in the NHF group, indicating deeper sedation. No adverse events attributable to interventions were observed. NHF reduced opioid requirements while maintaining oxygenation, ventilation, and sedation during ERCP. The ability of NHF to provide respiratory support, ensure adequate oxygenation, and allow monitoring of breathing makes it a promising modality during procedural sedation; however, further multi-center studies are needed. 072210047 [jRCTs].
如何引用
AMA
Tomotaka Mori, Takao Ayuse, Shuntaro Sato, Taiga Ichinomia, Rintaro Yano, Akane Shimakura, et al. Respiratory Support With Nasal High Flow Reduces Opioid Requirements During Endoscopic Retrograde Cholangiopancreatography.. DEN open. 2027; doi:10.1002/deo2.70421.
APA
Tomotaka Mori, Takao Ayuse, Shuntaro Sato, Taiga Ichinomia, Rintaro Yano, Akane Shimakura, et al (2027). Respiratory Support With Nasal High Flow Reduces Opioid Requirements During Endoscopic Retrograde Cholangiopancreatography.. DEN open. https://doi.org/10.1002/deo2.70421
GB/T 7714
Tomotaka Mori, Takao Ayuse, Shuntaro Sato, Taiga Ichinomia, Rintaro Yano, Akane Shimakura, et al. Respiratory Support With Nasal High Flow Reduces Opioid Requirements During Endoscopic Retrograde Cholangiopancreatography.[J]. DEN open, 2027 doi:10.1002/deo2.70421.
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