体位因素对肥胖患者无痛胃镜检查术中咽喉反流的影响  

Effect of different head height lateral decubitus positions on painless gastroscopy in obese patients for Laryngopharyngeal reflux

作　　者：田小威 贺亚楠 马作军 王冬梅[2] 贾利军 TIAN Xiaowei;HE Yanan;MA Zuojun;WANG Dongmei;JIA Lijun(Department of Anesthesiology and Perioperative Medicine,First Af filiated Hospital of Zhengzhou University,Zhengzhou450002,China;Department of Gastroenterology,First Af filiated Hospital of Zhengzhou University,Zhengzhou450002,China)

机构地区：[1]郑州大学第一附属医院麻醉与围手术期及疼痛医学部,河南郑州450002 [2]郑州大学第一附属医院消化内科医学部,河南郑州450002

出　　处：《中国实验诊断学》2024年第7期819-823,共5页Chinese Journal of Laboratory Diagnosis

基　　金：河南省医学科技攻关计划项目(2018020144)。

摘　　要：目的 探讨体位因素对肥胖患者无痛胃镜检查(Painless Gastroscopy)术中咽喉反流(Laryngopharyngeal Reflux)的影响。方法 选择郑州大学第一附属医院择期拟行无痛胃镜检查术的患者120例,性别不限,年龄18~64岁,BMI 28.0~32.0 kg/m^(2),ASA分级Ⅰ或Ⅱ级,采用随机数字表法分为3组(n=40):头高15°左侧卧位组(H15°组)、头高30°左侧卧位组(H30°组)和左侧卧位(C组)°在胃镜检查围手术期间,H15°组床头端抬高15°;H30°组床头端抬高30°;对照组床头端无抬高,常规进行胃镜下检查和/或活组织检查,在术中反流即刻或术毕检测咽喉腔粘液胃蛋白酶,患者苏醒后转入麻醉恢复室(PACU)进行麻醉恢复期监护。记录术前、术中和PACU期的心率(HR)、血压(BP)和血氧饱和度(SpO2);观察术中咽喉反流、呛咳、体动、低氧血症、低血压和心动过速的发生情况,记录PACU驻留时间、不良反应、舒适度评分和焦虑评分。结果 与C组比较,H15°组和H30°组术中咽喉反流发生率较低,呛咳发生率较低,低氧血症发生率较低(P<0.001)。H15°组和H30°组比较,各指标差异无统计学意义(P>0.05)。结论 头高15°和头高30°左侧卧位均是一种降低肥胖患者镇静状态下咽喉反流的有效措施。Objective To investigate the effect of different head high lateral decubitus positions on laryngopharyngeal reflux in patients undergoing painless gastroscopy.Methods A total of 120 patients with the history of acid reflux underwent elective painless gastroscopy, with no gender limit, BMI 28.0~32.0 kg/m~2,ASA grade Ⅰ or Ⅱ.They were divided into 3 groups(n=40) using the random number table method: head height 15 Left decubitus group(H15°group),head height 30 Left decubitus group(H30°group) and the control group in the left decubitus position(H0°group).Before gastroscopy, H15° group with 15° heads elevated during the perioperative period H30°.The group had 30° heads elevated during the perioperative period.In the observation group, the patients were placed in the left decubitus position(no head elevation) during the perioperative period.After the operation, he was transferred to the Anesthesia Recovery Unit(PACU).The number of coughs, reflux and oxygen saturation, heart rate and blood pressure were recorded before surgery, admission to the examination room, anesthesia induction, 5 min after the start of surgery, at the end of examination and during the anesthesia recovery period.Results With H0° Group comparison, H15° Group and H30°.In the group, the incidence of intraoperative throat reflux, cough and hypoxemia was low(P<0.05).H15°Group and H30°Group comparison, there was no significant difference between the indicators(P>0.05).Conclusion The head height 15°Left lateral decubitus position is effective in reducing the incidence of laryngopharyngeal reflux during painless gastroscopy in obese patients.

关 键 词：肥胖 头高侧卧位 咽喉腔黏液 反流 呛咳 低氧血症 

分 类 号：R767[医药卫生—耳鼻咽喉科]