近日，浙江大学医学院方向明团队研究了侧卧位与仰卧位对镇静成人低氧血症的影响。2025年8月19日出版的《英国医学杂志》发表了这一最新研究成果。

为了评估侧位与仰卧位对镇静患者低氧血症发生率的影响，并为呼吸策略提供基于证据的建议，2024年7月至11月，研究组在中国14家三级医院进行了一项前瞻性、多中心、随机对照试验。2159名成年人（≥18岁）接受镇静治疗。镇静患者被随机分配（1:1）接受侧位或传统仰卧位，按研究中心分层。

主要终点是定位后10分钟内低氧血症（外周血氧饱和度(SpO₂)≤90%）的发生率。次要结局包括气道抢救干预、严重低氧血症（SpO₂≤85%）发生率、记录的最低血氧饱和度、麻醉后护理单元的住院时间和安全措施（如心动过缓、心动过速、低血压、新发心律失常）。在意向治疗基础上进行分析。需要针对高龄和高体重指数患者进行进一步的重复性研究，以提高研究结果的普遍性。

在随机分组的2159例患者中，2143例纳入初步分析。患者平均年龄53.1岁，平均体重指数23.9，女性占53.7%（1150/2143）。侧卧组低氧血症发生率明显低于仰卧组(5.4% (58/1073)vs 15.0% (161/1070)；调整后风险比0.36,95%可信区间（CI） 0.27 ~ 0.49；术中,0.001)。与仰卧位组相比，侧卧位组患者需要的气道抢救干预较少(6.3% (68/1073)vs 13.8% (148/1070)；调整后风险比0.46,0.34 ~ 0.61；P<0.001)，严重低氧血症的发生率较低(0.7% (8/1073)vs 4.8% (51/1070)；调整后风险比0.16,0.07 ~ 0.33；P<0.001)，并且平均最低SpO₂水平较高（96.9% v 95.7%，绝对校正平均差1.20%,95% CI 0.87%至1.54%;P<0.001）。此外，侧卧组麻醉后护理室的住院时间较短（38.2 vs 40.5分钟；绝对校正平均差为2.22分钟；95% CI为3.63 ~ 0.80；P=0.002）。两组间的安全性结果具有可比性，但侧卧组心动过速发生率较低。

研究结果表明，将镇静的成人置于侧位可显著降低低氧血症的发生率和严重程度，并在不影响安全性的情况下减少气道抢救干预的需要。由于其简单和低成本，侧卧位可以在远程或资源有限的临床中提供优势。

附：英文原文

Title: Effect of lateral versus supine positioning on hypoxaemia in sedated adults: multicentre randomised controlled trial

Author: Hui Ye, Li-Hua Chu, Guo-Hao Xie, Ye-Jing Hua, Yi Lou, Qiao-Hong Wang, Zhi-Xin Xu, Meng-Yan Tang, Bing-Duo Wang, Hui-Yi Hu, Jing Ying, Tian Yu, Hai-Ying Wang, Yuan Wang, Zhi-Jian Ye, Xiao-Fang Bao, Ming-Cang Wang, Ling-Yang Chen, Xiao-Xia Wang, Xing-Bo Zhang, Chang-Shun Huang, Jun Wang, Ya-Ping Lu, Fo-Quan Luo, Wang Zhou, Chuan-Guang Wang, Hao Cheng, Wen-Jie Liu, Jie Luo, Yan-Qin Wu, Ru-Ru Li, Dong Wang, Ling-Qian Hou, Lu Shi, Jun Zhang, Kun Wang, Xin Pi, Rong Zhou, Qin-Qin Yang, Pei-Ling Wan, Hui Li, Shui-Jing Wu, Sheng-Wen Song, Ping Cui, Liqi Shu, Nazrul Islam, Xiang-Ming Fang

Issue&Volume: 2025/08/19

Abstract:

Objectives To evaluate the effect of lateral versus supine positioning on incidence of hypoxaemia in sedated patients and to provide evidence based recommendations for respiratory strategies.

Design Prospective, multicentre, randomised controlled trial.

Setting 14 tertiary hospitals in China, July to November 2024.

Participants 2159 adults (≥18 years) who underwent sedation.

Interventions Sedated patients were randomly assigned (1:1) to receive either lateral positioning or conventional supine positioning, stratified by study centres.

Main outcome measures The primary outcome was incidence of hypoxaemia (peripheral oxygen saturation (SpO2) ≤90%) within the first 10 minutes after positioning. Secondary outcomes included airway rescue interventions, incidence of severe hypoxaemia (SpO2 ≤85%), lowest oxygen saturation recorded, length of stay in the post-anaesthesia care unit, and safety measures (eg, bradycardia, tachycardia, hypotension, new onset arrhythmia). Analyses were performed on an intention-to-treat basis.

Results Of 2159 patients randomised, 2143 were included in the primary analysis. The mean age of the patients was 53.1 years, mean body mass index was 23.9, and 53.7% (1150/2143) were women. The incidence of hypoxaemia was significantly lower in the lateral group compared with supine group (5.4% (58/1073) v 15.0% (161/1070); adjusted risk ratio 0.36, 95% confidence interval (CI) 0.27 to 0.49; P<0.001). Compared with patients in the supine group, patients in the lateral group required fewer airway rescue interventions (6.3% (68/1073) v 13.8% (148/1070); adjusted risk ratio 0.46, 0.34 to 0.61; P<0.001), had a lower incidence of severe hypoxaemia (0.7% (8/1073) v 4.8% (51/1070); adjusted risk ratio 0.16, 0.07 to 0.33; P<0.001), and had a higher mean lowest SpO2 level (96.9% v 95.7%, absolute adjusted mean difference 1.20%, 95% CI 0.87% to 1.54%; P<0.001). Additionally, length of stay in the post-anaesthesia care unit was shorter in the lateral group (38.2 v 40.5 minutes; absolute adjusted mean difference 2.22 minutes; 95% CI 3.63 to 0.80; P=0.002). Safety outcomes were comparable between the groups, but tachycardia was less frequent in the lateral group.

Conclusions Placing sedated adults in the lateral position significantly reduces the incidence and severity of hypoxaemia and decreases the need for airway rescue interventions without compromising safety. Given its simplicity and low cost, lateral positioning could offer advantages in remote or resource constrained clinical settings. Further replication studies targeting patients with advanced age and high body mass index are needed to improve the generalisability of the findings.

DOI: 10.1136/bmj-2025-084539

Source: https://www.bmj.com/content/390/bmj-2025-084539