目的 优化肺部疾病婴儿接受支气管镜检查时的氧疗方案。 方法 该研究是一项前瞻性随机、对照的单中心临床试验。前瞻性选择2019年7月—2021年7月42例接受电子支气管镜检查的婴儿为研究对象。按照随机数字表法分为鼻导管吸氧（nasal cannula oxygen, NC）组及改良T组合复苏器（T-piece resuscitator, TPR）组。记录两组术中最低血氧饱和度结果作为主要指标，术中心率及呼吸结果作为次要指标。 结果 改良TPR组术中最低血氧饱和度高于NC组，低氧血症发生率低于NC组（P<0.05）；改良TPR组术中有6例患儿轻度低氧、2例中度低氧及1例重度低氧，NC组分别有3、5和9例，差异有统计学意义（P<0.05）。改良TPR组术中呼吸节律异常发生率低于NC组（P<0.05），两组心律失常发生率差异无统计学意义（P>0.05）。 结论 改良TPR可以显著减少肺部疾病婴儿接受电子支气管镜时发生低氧血症的风险；与传统NC相比，TPR可明显改善低氧血症的严重程度，且减少呼吸节律异常的发生率。
Abstract
Objective To optimize the oxygen therapy regimens for infants with pulmonary diseases during bronchoscopy. Methods A prospective randomized, controlled, and single-center clinical trial was conducted on 42 infants who underwent electronic bronchoscopy from July 2019 to July 2021. These infants were divided into a nasal cannula (NC) group and a modified T-piece resuscitator (TPR) group using a random number table. The lowest intraoperative blood oxygen saturation was recorded as the primary outcome, and intraoperative heart rate and respiratory results were recorded as the secondary outcomes. Results Compared with the NC group, the modified TPR group had a significantly higher level of minimum oxygen saturation during surgery and a significantly lower incidence rate of hypoxemia (P<0.05). In the modified TPR group, there were 6 infants with mild hypoxemia, 2 with moderate hypoxemia, and 1 with severe hypoxemia, while in the NC group, there were 3 infants with mild hypoxemia, 5 with moderate hypoxemia, and 9 with severe hypoxemia (P<0.05). The modified TPR group had a significantly lower incidence rate of intraoperative respiratory rhythm abnormalities than the NC group (P<0.05), but there was no significant difference in the incidence rate of arrhythmias between the two groups (P>0.05). Conclusions Modified TPR can significantly reduce the risk of hypoxemia in infants with pulmonary diseases during electronic bronchoscopy, and TPR significantly decreases the severity of hypoxemia and the incidence of respiratory rhythm abnormalities compared with traditional NC.
关键词
T组合复苏器 /
鼻导管吸氧 /
电子支气管镜 /
临床效果 /
婴儿
Key words
T-piece resuscitator /
Nasal cannula oxygen /
Electronic bronchoscopy /
Clinical efficacy /
Infant
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参考文献
1 Arwas N, Goldbart A, Aviram M, et al. Flexible bronchoscopy in pediatric patients with Down syndrome: a case-control study of the indications, findings, and complications[J]. Pediatr Pulmonol, 2023, 58(6): 1658-1664. PMID: 36811243. DOI: 10.1002/ppul.26371.
2 Schnapf BM. Oxygen desaturation during fiberoptic bronchoscopy in pediatric patients[J]. Chest, 1991, 99(3): 591-594. PMID: 1995213. DOI: 10.1378/chest.99.3.591.
3 Patolia S, Farhat R, Subramaniyam R. Bronchoscopy in intubated and non-intubated intensive care unit patients with respiratory failure[J]. J Thorac Dis, 2021, 13(8): 5125-5134. PMID: 34527353. PMCID: PMC8411155. DOI: 10.21037/jtd-19-3709.
4 Hinder M, Tracy M. Newborn resuscitation devices: the known unknowns and the unknown unknowns[J]. Semin Fetal Neonatal Med, 2021, 26(2): 101233. PMID: 33773952. DOI: 10.1016/j.siny.2021.101233.
5 Drevhammar T, Falk M, Donaldsson S, et al. Neonatal resuscitation with T-piece systems: risk of inadvertent PEEP related to mechanical properties[J]. Front Pediatr, 2021, 9: 663249. PMID: 34164358. PMCID: PMC8215339. DOI: 10.3389/fped.2021.663249.
6 国家卫生健康委员会人才交流服务中心儿科呼吸内镜诊疗技术专家组, 中国医师协会儿科医师分会内镜专业委员会, 中国医师协会内镜医师分会儿科呼吸内镜专业委员会, 等. 中国儿科可弯曲支气管镜术指南（2018年版）[J]. 中华实用儿科临床杂志, 2018, 33(13): 983-989. DOI: 10.3760/cma.j.issn.2095-428X.2018.13.006.
7 Takzare A, Ariana P, Malekianzadeh B, et al. Comparing topical administration of lidocaine alone and in combination with alfentanil in children undergoing bronchoscopy[J]. J Family Med Prim Care, 2021, 10(3): 1332-1335. PMID: 34041174. PMCID: PMC8140266. DOI:10.4103/jfmpc.jfmpc_1719_20.
8 Sharluyan A, Osona B, Frontera G, et al. High flow nasal cannula versus standard low flow nasal oxygen during flexible bronchoscopy in children: a randomized controlled trial[J]. Pediatr Pulmonol, 2021, 56(12): 4001-4010. PMID: 34506689. DOI: 10.1002/ppul.25655.
9 Carlens J, Fuge J, Price T, et al. Complications and risk factors in pediatric bronchoscopy in a tertiary pediatric respiratory center[J]. Pediatr Pulmonol, 2018, 53(5): 619-627. PMID: 29393584. DOI: 10.1002/ppul.23957.
10 DeBoer EM, Prager JD, Kerby GS, et al. Measuring pediatric bronchoscopy outcomes using an electronic medical record[J]. Ann Am Thorac Soc, 2016, 13(5): 678-683. PMID: 26816220. PMCID: PMC6137899. DOI: 10.1513/AnnalsATS.201509-576OC.
11 Abulebda K, Abu-Sultaneh S, Ahmed SS, et al. Intensivist-based deep sedation using propofol for pediatric outpatient flexible bronchoscopy[J]. World J Crit Care Med, 2017, 6(4): 179-184. PMID: 29152464. PMCID: PMC5680344. DOI: 10.5492/wjccm.v6.i4.179.
12 Li J, Scott JB, Lee JH. Defining the optimal role of high-flow nasal cannula in pediatric procedural sedation[J]. Pediatr Pulmonol, 2020, 55(12): 3225-3227. PMID: 33048458. DOI: 10.1002/ppul.25105.
基金
国家重点研发计划（2021YFC2701700，2021YFC2701704）。
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