上消化道内镜手术患者口咽部压力性损伤的相关因素分析  

Factors associated with oropharyngeal pressure injury in patients undergoing upper gastrointestinal endoscopic surgery

作　　者：吴宇[1,2] 李勇 何健[1,2] 刘小伟 WU Yu;LI Yong;HE Jian;LIU Xiao-wei(Department of Gastroenterology,Xiangya Hospital,Central South University,Changsha,410008,China;Hunan International Scientific and Technological Cooperation Base of Artificial Intelligence Computer Aided Diagnosis and Treatment for Digestive Disease,Changsha,410008,China.)

机构地区：[1]中南大学湘雅医院消化内科,410008 [2]湖南省人工智能辅助消化病诊疗国际科技创新合作基地

出　　处：《现代消化及介入诊疗》2022年第4期434-438,共5页Modern Interventional Diagnosis and Treatment in Gastroenterology

摘　　要：目的分析上消化道内镜手术患者口咽部损伤原因,并探讨其防护措施。方法回顾性分析2020年6月至2021年6月中南大学湘雅医院行上消化道内镜下3-4级手术治疗的482例患者的临床资料,进镜和退镜时均对口咽部黏膜进行拍照留图和视频录像。根据有无口咽部损伤分为损伤组及无损伤组。通过电子病历系统收集患者的临床及手术资料,采用单因素分析及多因素分析方法探究影响口咽部损伤的因素。结果发现最终有11名患者口咽部有不同程度的损伤,约占比2.2%。单因素分析显示手术时间、糖尿病、术中药物使用(肌肉注射山莨菪碱10 mg/1 mL)与患者的口咽部损伤有关(P<0.05)。进一步多因素分析显示,术中药物使用(肌肉注射山莨菪碱10 mg/1 mL)是影响口咽部损伤的独立影响因素(OR=3.412,95CI%=2.411~4.736,P=0.007)。结论对于上消化道内镜下治疗患者肌肉注射山莨菪碱或术中发现口腔黏膜干涩,内镜进出有明显的阻力时,需要仔细观察患者口咽部尤其软腭部位有无损伤,进一步预防和减轻上消化道内镜下治疗患者的口咽部黏膜压力性损伤值得继续探索。Objective To analyze the causes of oropharyngeal injury in patients undergoing upper gastrointestinal endoscopic surgery,and to formulate some protective measures.Methods The study enrolled the patients who underwent upper gastrointestinal endoscopy grade 3-4 surgical treatment in the Xiangya Hospital from June 2020 to June 2021.The oropharyngeal mucosa was photographed at the time of endoscopy.The retention maps and video recordings were compared.The patients were divided into two groups depending on the oropharyngeal injury.The data were collected through the electronic medical record system.Univariate and multivariate analyses were performed to investigate the factors affecting pharyngeal injury.Results A total of 482 patients were retrospectively screened in the study,including 279 males and 203 females,with a mean age of 46.5±12.6 years and a median operative time of 23.0(20.5,65.0)minutes.Ultimately 11 patients had varying degrees of damage to the oropharynx,accounting for approximately 2.2%.Univariate analysis showed that operation time,diabetes,intraoperative drug use(intramuscular injection of scopolamine 10 mg/1 mL)were associated with oropharyngeal injury(P<0.05).Multivariate analysis revealed that intraoperative drug use(intramuscular injection of scopolamine 10 mg/1 mL)was an independent influencing factor on oropharyngeal injury(OR=3.412,95 CI%=2.411-4.736,P=0.007).Conclusion For patients treated with upper gastrointestinal endoscopy by intramuscular injection of scopolamine,careful observation of the patient′s oropharynx,especially the soft palate region,is needed.Further prevention and reduction of their oropharyngeal mucosal pressure injury deserve continued exploration.

关 键 词：上消化道 内镜下治疗 口咽部损伤 原因分析 

分 类 号：R573.9[医药卫生—消化系统]