旁流式呼气末二氧化碳分压监测在消化内镜麻醉中的应用  

Clinical application of sidestream PETCO2 monitoring during gastrointestinal endoscopic anesthesia

作　　者：张霞 密夫丽 孙传玉[1] 郭蕾[1] 赵琼 阚洪源 Zhang Xia;Mi Fuli;Sun Chuanyu;Guo Lei;Zhao Qiong;Kan Hongyuan(Department of Endoscopy,First Affiliated Hospital of Shandong First Medical University(Shandong Qianfoshan Hospital),Jinan 250014,China)

机构地区：[1]山东第一医科大学第一附属医院(山东省千佛山医院)内镜诊疗科,济南250014

出　　处：《中华消化病与影像杂志（电子版）》2020年第6期244-247,共4页Chinese Journal of Digestion and Medical Imageology(Electronic Edition)

基　　金：山东省医药卫生科技发展计划项目(2017ws283)。

摘　　要：目的分析旁流式呼气末二氧化碳分压(PETCO2)监测在消化内镜麻醉中应用的临床价值及意义。方法选取山东省千佛山医院内镜诊疗科2020年3月至2020年5月期间行消化内镜麻醉患者200例,随机分为试验组(鼻导管吸氧+PETCO2监测,n=100)和对照组(仅鼻导管吸氧,n=100)。置镜前2 min,静脉注射地佐辛1~3 mg,丙泊酚1.5~3 mg/kg,待患者睫毛反射消失,托下颌无反应时,开始置镜,置镜成功后予丙泊酚3~5 mg/kg^-1·h^-1持续泵注输入直至检查结束。比较两组患者麻醉效果及并发症发生率。结果两组患者年龄、性别、体质量指数、ASA分级、麻醉诱导时间、内镜检查时间均无差异(P>0.05);试验组患者低氧血症发生率、面罩加压给氧率、恶心呕吐率、丙泊酚用量、苏醒时间低于对照组,差异有统计学意义(P<0.05);试验组呼吸暂停发现次数、托下颌率、挤压胸廓辅助呼吸率高于对照组,差异有统计学意义(P<0.05)。结论经鼻导管旁流式PETCO2监测有利于及时观察肺通气状态,指导临床干预,降低并发症,缩短苏醒时间,提高消化内镜麻醉质量。Objective To analyze the clinical value and significance of partial pressure of end-tidal carbon dioxide(PETCO2)monitoring during gastrointestinal endoscopic anesthesia.Methods A total of 200 patients who underwent gastroscopy and colonoscopy under general anesthesia in Department of Endoscopy of Shandong Qianfoshan Hospital from March 2020 to May 2020 were selected and randomly divided into experimental group(oxygen was inhaled via nasal catheter,and pulmonary ventilation was monitored by sidestream PETCO2 monitoring device,n=100)and control group(only oxygen was inhaled via nasal catheter,n=100).Dezocine 1-3 mg and propofol 1.5-3 mg/kg were administrated 2 minutes before the lens was placed.After the eyelash reflex disappeared,and the mandible did not respond,the endoscope was inserted.After the lens was successfully placed,propofol was continuously pumped at 3-5 mg/kg/h until the end of the operation.The anesthesia effect and the incidence of complications were compared between the two groups.Results There was no significant difference in age,gender,body mass index,ASA grade,anesthesia induction time and endoscopic examination time between the two groups(P>0.05).The incidence of hypoxemia,the frequency of mask pressurization,the rate of nausea and vomiting,the dosage of propofol and the recovery time in the experimental group were lower than those in the control group(P<0.05).The frequency of apnea,the incidence of jaw-lift and chest compressions to aid breathing in the experimental group were higher than those in the control group(P<0.05).Conclusion The monitoring of PETCO2 can detect the status of lung ventilation,guide clinical intervention,reduce complications,shorten the recovery time,and improve the quality of gastrointestinal endoscopic anesthesia.

关 键 词：消化内镜 呼气末二氧化碳分压 低氧血症 呼吸暂停 

分 类 号：R61[医药卫生—外科学]