湿化高流量鼻导管通气在肥胖患者中度镇静下无痛胃镜检查的应用  

作　　者：郭丰[1] 邹颖华 王兰[1] 冯睿[1] 于桂杰[1] 

机构地区：[1]上海中医药大学附属曙光医院,201203

出　　处：《浙江临床医学》2023年第6期897-899,共3页Zhejiang Clinical Medical Journal

基　　金：上海市卫生健康委员会科研课题资助项目(201940062)。

摘　　要：目的湿化高流量鼻导管通气在肥胖患者中度镇静下无痛胃镜检查的临床应用。方法择期静脉麻醉下行胃镜检查的肥胖患者60例,ASA分级Ⅰ或Ⅱ级;年龄18~65岁,28 kg/m^(2)≤BMI≤40 kg/m^(2),采用随机数字表法分为2组(n=30):鼻导管吸氧组(C组)和湿化高流量鼻导管通气组(T组)。C组经鼻导管吸纯氧6 L/min,T组连接湿化高流量鼻导管通气装置吸纯氧30 L/min,两组均给予咪唑安定复合小剂量瑞芬太尼镇静。记录两组患者气道评估情况(Mallampati分级)、入室基础氧饱和度、BMI、咪达唑仑、瑞芬太尼用量;记录胃镜检查时间、苏醒室观察时间;记录患者入室即刻、进镜后1 min、退镜后1 min和出复苏室的平均动脉压、心率、血氧饱和度;记录胃镜检查过程中的呼吸抑制及缺氧不良事件处理情况;记录检查期间体动、恶心、呕吐、呛咳、术后头晕和术后鼻腔不良反应发生情况;记录患者、内镜医生和麻醉医生的主观满意度评分。结果两组进镜后1 min与入室即刻比较患者心率、血压明显降低(P<0.05);与C组比较,T组亚临床呼吸抑制和缺氧发生率降低,不良事件处理使用率降低(P<0.05)。经过唤醒和托下颌等简单处理均可纠正缺氧情况。结论湿化高流量鼻导管通气用于肥胖患者中度镇静下无痛胃镜检查更安全、有效。Objective To evaluate the clinical application of humidified high flow nasal catheter ventilation in painless gastroscopy under moderate sedation in obese patients.Methods 60 obese patients underwent gastroscopy under selective intravenous anesthesia,ASA grade I or II,age 18~65 years old,28 kg/m^(2)≤body mass index(BMI)≤40 kg/m^(2)were randomly divided into two groups(n=30):the nasal catheter oxygen inhalation group(Group C)and the humidified high flow nasal catheter ventilation group(group T).The group C inhaled pure oxygen 6 L/min through nasal catheter,and the group T connected with humidified high flow nasal catheter ventilation device to inhale pure oxygen 30 L/min.Both groups were given midazolam combined with low-dose remifentanil for sedation.Airway assessment(Mallampati grade),basic oxygen saturation,BMI,midazolam and remifentanil were recorded.The time of gastroscopy and observation in the recovery room were recorded.Blood oxygen saturation,mean arterial pressure and heart rate were recorded immediately after entering the room,1 minute after gastroscopy,1 minute after exiting gastroscopy and out of the recovery room.The treatment of respiratory depression and adverse events of hypoxia during gastroscopy was recorded.Adverse reactions such as body movement,nausea,vomiting,choking cough,postoperative dizziness and postoperative nasal were recorded during the examination.The subjective satisfaction scores of patients,endoscopists and anesthesiologists were recorded.Results The heart rate and blood pressure of the two groups were significantly lower than those after entering the room(P<0.05).Compared with the group C,the incidence of respiratory depression in the group T decreased(P<0.05),and the utilization rate of adverse event treatment decreased,with statistical significance(P<0.05).After simple treatment such as awakening and supporting the jaw,the hypoxia could be corrected.Conclusion Humidified high flow nasal catheter ventilation is safer and more effective for painless gastroscopy under moderat

关 键 词：肥胖 无痛胃镜 中度镇静 湿化高流量鼻导管通气 

分 类 号：R614[医药卫生—麻醉学]