Objective: To investigate the effect and safety of transnasal humidified rapid insufflation ventilatory exchange (THRIVE) technique in hysteroscopic diagnostic and therapeutic surgery. Methods: This study was a randomized controlled trial. A total of 100 female patients undergoing hysteroscopy surgery at Beijing Tongren Hospital from September to December 2023 were selected and randomly divided into two groups by the random number table method: the THRIVE group and the mask oxygen group, with 50 patients in each group. Patients in both groups were given total intravenous anesthesia with propofol combined with remifentanil and preserved spontaneous respiration. The THRIVE group was given oxygen by the THRIVE device with an oxygen flow rate of 50 L/min, while the mask oxygen group was given oxygen by the mask with an oxygen flow rate of 5 L/min; the oxygen concentration of both groups was set at 100%. The general condition of the patients, vital signs during the operation, the amount of anesthesia drugs used and the operation time were recorded. The primary observation index was the incidence of hypoxic events in the two groups; the secondary observation indexes were the incidence and time of intraoperative apnea as well as the corresponding oxygenation interventions and the incidence of non-hypoxic adverse events. Results: The age of the THRIVE group was (42±14) years, and the age of the mask oxygen group was (43±15) years. The duration of surgery in the THRIVE group was (15.9±3.4) min, which was statistically lower than that of the mask oxygen group (16.3±4.5) min (P=0.041), and there were no differences observed in the duration of awakening time and anesthesia time (both P>0.05). There was no significant difference in the dosage of propofol, remifentanil, and intraoperative vasoactive drugs between the two groups (all P>0.05). The SpO2 of the patients in the THRIVE group at the end of the operation was (99.7±1.1) %, which was higher than that of the mask-oxygen group (99.1±1.1) % (P<0.05). There was no difference in SpO2 of the two groups at the other time points (all P>0.05). There were no differences in HR and MAP of two group patients at each time point (all P>0.05). The incidence of hypoxic events in the THRIVE group was 12.0% (6/50), which was lower than that of 28.0% (14/50) in the mask oxygen group (P=0.045). The difference in the incidence and duration of apnea between the two groups was not statistically significant (all P>0.05). There were no cases of temporary need for laryngeal mask or tracheal intubation during surgery in both groups. There was no statistically significant difference in the incidence of intraoperative body movement, dizziness, nausea and vomiting between the two groups (all P>0.05), and no cardiac, cerebral, renal or other important organ insufficiency occurred in the two weeks after surgery. Conclusion: THRIVE technology can provide effective oxygenation for patients undergoing hysteroscopic diagnosis and treatment, maintain patients' circulatory stability, and improve the safety and efficiency of surgery.
目的： 探讨经鼻湿化快速充气交换通气（THRIVE）技术在宫腔镜诊疗术中的应用效果及安全性。 方法： 本研究为随机对照试验。选取2023年9至12月北京同仁医院拟行择期宫腔镜诊疗术的女性患者100例，采用随机数字表法分为两组：THRIVE组和面罩吸氧组，每组各50例。两组患者均采用保留自主呼吸的丙泊酚复合瑞芬太尼全凭静脉麻醉，THRIVE组采用THRIVE设备供氧，氧流量为50 L/min；面罩吸氧组采用面罩吸氧方式，氧流量为5 L/min；两组氧浓度均设置为100%。记录患者的一般情况、手术期间生命体征、麻醉药物使用量及手术时间等。主要观察指标为两组患者低氧事件发生率；次要观察指标为术中呼吸暂停发生率和时间以及相应氧合干预手段、非缺氧不良事件发生率等。 结果： THRIVE组年龄（42±14）岁，面罩吸氧组年龄（43±15）岁。THRIVE组患者手术时长为（15.9±3.4）min，低于面罩吸氧组的（16.3±4.5）min（P=0.041），而苏醒时长和麻醉时长差异均无统计学意义（均P>0.05）。两组患者丙泊酚、瑞芬太尼、术中血管活性药用量差异均无统计学意义（均P>0.05）。THRIVE组患者手术结束即刻脉搏血氧饱和度（SpO2）为（99.7±1.1）%，高于面罩吸氧组的（99.1±1.1）%（P<0.05），两组患者其他时间点的SpO2以及各时间点心率和平均动脉压（MAP）差异均无统计学意义（均P>0.05）。THRIVE组低氧事件发生率为12.0%（6/50），低于面罩吸氧组的28.0%（14/50）（P=0.045）。两组患者呼吸暂停发生率及时长差异均无统计学意义（均P>0.05）。两组患者手术期间均无临时需要置喉罩或气管插管的病例。两组患者术中体动、头晕、恶心呕吐发生率差异均无统计学意义（均P>0.05），术后2周均未发生心、脑、肾等重要脏器功能不全。 结论： THRIVE技术可以为宫腔镜诊疗术患者提供有效的氧合，维持患者循环稳定，提高手术的安全性和效率。.