麻醉胃镜检查中低氧血症的危险因素分析  

Risk factors for hypoxemia during routine anesthesia for gastrointestinal endoscopy

作　　者：封莉莉[1] 丁文霞 孙媛媛 张莹莹 袁宁平 张丽君[1] 韩文军[1] 席惠君 Li-Li Feng;Wen-Xia Ding;Yuan-Yuan Sun;Ying-Ying Zhang;Ning-Ping Yuan;Li-Jun Zhang;Wen-Jun Han;Hui-Jun Xi(Department of Anesthesiology,Changhai Hospital,Shanghai 200433,China;Digestive Endoscopy Center,Changhai Hospital,Shanghai 200433,China)

机构地区：[1]上海长海医院麻醉科,上海市200433 [2]上海长海医院消化内镜中心,上海市200433

出　　处：《世界华人消化杂志》2019年第7期427-434,共8页World Chinese Journal of Digestology

摘　　要：背景麻醉胃镜检查已经作为一种常规胃镜检查方式在国内开展.低氧血症仍然是麻醉胃镜检查中发生率较高的不良事件,但国外就其发生率的报道情况相差较大(<1%至85%),国内缺乏相关高质量报道.丙泊酚作为用于门诊患者麻醉胃镜检查的镇静药物,其安全、有效性已经得到认可,《中国消化内镜诊疗镇静/麻醉的专家共识意见》(2014年)推荐使用,国外仍然有对其安全性的质疑,本研究中,我们将其作为门诊患者胃镜检查的镇静药物使用,观察其对低氧血症发生率的影响.目的观察麻醉胃镜检查中低氧血症的发生率,并分析其危险因素.方法纳入上海长海医院消化内镜中心2018-09-01/2018-11-30经麻醉医师施行丙泊酚镇静的门诊麻醉胃镜检查患者,共计580例.观察患者在检查过程中有无低氧血症,记为发生低氧血症(110例)和未发生低氧血症(470例)两组,记录两组患者的基本信息、麻醉过程和内镜操作相关信息.结果单因素分析发现打鼾史、活检、年龄、体重指数、腹围、内镜操作时间、丙泊酚的量、患者A S A分级、内镜医师分级在两组间存在差异(P <0.05).多因素Logistic回归分析,发现年龄(>75岁, OR值8.955, 95%CI:2.070-38.746)和丙泊酚用量(>197 mg,OR值2.360,95%CI:1.320-4.219)是低氧血症的独立危险因素.结论对高龄患者(特别是>75岁患者)和需要较大量丙泊酚(特别是>197mg)镇静的患者需要加以主动干预,以预防低氧血症的发生.BACKGROUND Gastrointestinal endoscopy under anesthesia has been carried out as a routine procedure in China. Hypoxemia is still an adverse event with a high incidence in routine anesthesia for gastrointestinal endoscopy, but the incidence of hypoxemia varies greatly across countries (< 1% to 85%), and there is a lack of relevant high-quality reports in China. Propofol, as a sedative for anesthetic gastroscopy in outpatients, has been recognized for its safety and effectiveness and is recommended by the expert consensus on Sedation/Anesthesia for Digestive Endoscopic Diagnosis and Treatment in China (2014). However, there are still some debate over its safety in foreign countries. In this study, we used propofol as a sedative for gastroscopy in outpatients to observe its effect on the incidence of hypoxemia. AIM To observe and analyze the incidence of and risk factors for hypoxemia in anesthesia for gastrointestinal endoscopy. METHODS A total of 580 outpatients who were sedated with propofol from September 1, 2018 to November 30, 2018 in Digestive Endoscopy Center of Shanghai Changhai Hospital were included in the study. These patients were divided into either a hypoxemia (n = 110) group or a non-hypoxemia group (n = 470). The basic information, anesthesia procedure, and endoscopic operation related information of the two groups were recorded. RESULTS The information of patients in the two groups was compared and analyzed. It was found that there were significantly differences between the two groups in snoring history, biopsy, age, body mass index, abdominal circumference, endoscopic operation time, propofol dosage, ASA classification, and endoscopic physician classification (P < 0.05). Multivariate Logistic regression analysis showed that age (>5 years, OR = 8.955, 95 %CI: 2.070-38.746) and propofol dosage (>197 mg, OR = 2.360, 95 %CI: 1.320-4.219) were independent risk factors for hypoxemia. CONCLUSION Intervention is needed for elderly patients (especially patients over 75 years old) and patients requiring larg

关 键 词：麻醉/镇静 胃镜 低氧血症 危险因素 

分 类 号：R573[医药卫生—消化系统] R614[医药卫生—内科学]