摘要
目的评价快充式经鼻湿化高流量通气用于肥胖患者无痛胃镜检查术的效果。方法选择行无痛胃镜检查术的患者100例,性别不限,年龄18~64岁,ASA分级Ⅰ或Ⅱ级,BMI≥30 kg/m2,采用随机数字表法分为2组(n=50):鼻导管吸氧组(C组)和快充式经鼻湿化高流量通气组(T组)。C组经鼻导管吸纯氧8 L/min,T组连接快充式经鼻湿化高流量通气装置吸纯氧30 L/min。静脉注射负荷剂量丙泊酚1.5~2.5 mg/kg后,C组经鼻导管吸纯氧8 L/min,T组氧流量调整为70 L/min,随后开始胃镜操作。根据患者体征如呼吸加深、心率增快,甚至体动等,每次静脉注射丙泊酚0.2~0.5 mg/kg。记录胃镜检查时间、丙泊酚总用量和苏醒时间;记录T组术后5 min内和30 min内与通气相关不良事件(气道损伤和气压伤)发生情况。记录胃镜检查过程中与缺氧相关不良事件(亚临床呼吸抑制、缺氧和严重缺氧)发生情况和不良事件处理措施(增加通气氧流量、开放气道、面罩辅助通气和气管插管行机械通气)使用情况。记录患者、操作者和麻醉医生的主观满意度评分。记录胃镜检查过程中体动、呕吐、反流、支气管痉挛和呛咳等的不良反应发生情况。结果与C组比较,T组胃镜检查时间缩短,丙泊酚用量增加,亚临床呼吸抑制和缺氧发生率降低,开放气道使用率及面罩通气使用率降低,体动和呛咳发生率降低(P<0.05)。T组术后未见与通气相关不良事件的发生。结论快充式经鼻湿化高流量通气可安全、有效地用于肥胖患者无痛胃镜检查术。
Objective To evaluate the efficacy of transnasal humidified rapid insufflation ventilatory exchange(THRIVE)on painless gastroscopy in the obese patients.Methods One hundred male or female patients who needed painless gastroscopy,aged 18-64 yr,of American Society of Anesthesiologists physical statusⅠorⅡ,with body mass index≥30 kg/m2,were divided into 2 groups(n=50 each)using a random number table method:nasal catheter oxygen inhalation group(group C)and THRIVE group(group T).In group C,the pure oxygen was inhaled through the nasal catheter for 8 L/min,while oxygen at concentration of 100%was inhaled via the THRIVE device in group T.After the loading dose of propofol 1.5-2.5 mg/kg was given,pure oxygen 8 L/min was inhaled through the nasal catheter in group C,and the flow rate of oxygen was adjusted to 70 L/min in group T,and then endoscopic operation was started.Propofol 0.2-0.5 mg/kg was intravenously injected each time according to the patient′s physical signs,such as deepening of breathing,increased heart rate,and even body movement.The time for gastroscopy,total consumption of propofol and emergence time were recorded.Adverse events(airway injury or pulmonary barotrauma)related to ventilation were recorded within 5 and 30 min after operation in group T.The occurrence of adverse events related to hypoxia(subclinical respiratory depression,hypoxia and severe hypoxia)and use of treatment measures of adverse events(increasing ventilation oxygen flow,opening airway,mask-assisted ventilation and ventilation after tracheal intubation)were recorded.The subjective scores of patients,operators and anesthesiologists were recorded.The adverse events,including body movement,vomiting,reflux,bronchospasm and bucking were recorded during the examination.Results Compared with group C,the time for gastroscopy was sginificantly shortened,the consumption of propofol was increased,the incidence of subclinical respiratory depression and hypoxia was decreased,the requirement for opening airway and mask-assisted ventilation was decreased,and the body movement and bucking were decreased in group T(P<0.05).No ventilation-related adverse events occurred after operation in group T.Conclusion THRIVE can be safely and effectively used for painless gastroscopy in obese patients.
作者
徐亚杰
尹加林
张勇
谢欣怡
鲍红光
王晓亮
Xu Yajie;Yin Jialin;Zhang Yong;Xie Xinyi;Bao Hongguang;Wang Xiaoliang(Department of Anesthesiology,Nanjing First Hospital Nanjing Hospital Affiliated to Nanjing Medical University,Nanjing 210006,China)
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2020年第9期1125-1128,共4页
Chinese Journal of Anesthesiology
基金
南京市医学科技发展项目(YKK16141)。
关键词
投药
鼻内
吸入法
气道管理
肥胖症
胃镜检查
Administration,intranasal
Inhalation
Airway management
Obesity
Gastroscop
