摘要
目的探讨无痛结肠镜检查中,PETCO2预测低氧血症的敏感性,分析发生呼吸抑制的危险因素。方法选择2018年2月至3月择期行无痛结肠镜检查的患者120例,ASA分级Ⅰ、Ⅱ级。根据术中是否达到呼吸抑制[PETCO2≥50 mmHg(1 mmHg=0.133 kPa)或波形消失≥15 s],将患者分为呼吸抑制组(D组)与非呼吸抑制组(N组)。记录两组患者性别、年龄、手术时长、丙泊酚总用量、BMI、阻塞性睡眠呼吸暂停综合征(obstructive sleep apnea syndrome, OSAS)史,观察从呼吸抑制开始到低氧血症(SpO2<90%)出现的间隔时间,以及从低氧血症警报值出现到低氧血症的间隔时间。结果两组患者年龄、BMI、OSAS史比较差异有统计学意义(P<0.05),年龄及BMI是呼吸抑制独立危险因素。受试者工作特征曲线(receiver operating characteristic curve, ROC曲线)显示年龄、BMI以及年龄联合BMI对于呼吸抑制均具有一定预测作用,其中,年龄加BMI的ROC曲线下面积大于两独立变量。与N组比较,D组在预测低氧血症方面具有优势,两组差异有统计学意义(P<0.05)。监测PETCO2较传统的SpO2能更早地预测低氧血症的出现,其中呼吸抑制平均早于低氧血症(SpO2<90%)63.9 s。结论无痛结肠镜检查中高龄及BMI较大患者,更易出现呼吸抑制;监测PETCO2能够更加敏感地预测低氧血症的发生,为我们处理低氧血症提供充足时间,保证患者安全。
Objective To investigate the risk factors of respiratory depression and its sensitivity in predicting hypoxemia in painless colonoscopy. Methods A total of 120 patients [American Society of Anesthesiologists (ASA) grade Ⅰ-Ⅱ] who underwent painless colonoscopy from February to March 2018 were enrolled. The patients were divided into a respiratory depression group (group D) and a non-respiratory depression group (group N), according to whether respiratory depression [endtidal carbon dioxide partial pressure (PETCO2)≥50 mmHg (1 mmHg=0.133 kPa) or disappearance of waveform ≥15 s] was achieved during surgery. The following indicators of both groups were recorded: gender, age, length of examination, propofol doses, body mass index (BMI), obstructive sleep apnea syndrome (OSAS) history, the interval from respiratory depression to hypoxemia [pulse oxygen saturation (SpO2)<90%] and the interval from the onset of hypoxemia alert values to hypoxemia. Results Remarkable difference was found in age, BMI, and OSAS history between the two groups, while age and BMI were the independent risk factors for respiratory depression. According to receiver operating characteristic (ROC) curve, age, BMI, and both can predict respiratory depression to some extent. Notably, the area under the ROC curve for both age and BMI was greater, compared with age and BMI alone (P<0.05). Compared with group N, group D had advantages in predicting hypoxemia(P<0.05). Compared with traditional oxygen saturation value (SpO2), monitoring PETCO2 predicted hypoxemia earlier, with earlier respiratory depression (63.9 s) than hypoxemia on average (SpO2<90%). Conclusions Patients with older ages and high BMI in painless colonoscopy are more likely to present respiratory depression. Monitoring PETCO2 can be more sensitive to predict the occurrence of hypoxemia, providing sufficient time for our treatment of hypoxemia to guarantee patient safety.
作者
蒋宝峰
王金璇
翟学花
邓小明
Jiang Baofeng;Wang Jinxuan;Zhai Xuehua;Deng Xiaoming(Department of Anesthesiology, Weifang Medical College, Weifang 261053, China;Department of Anesthesiology, Weifang People′s Hospital, Weifang 261041, China;Faculty of Anesthesiology, Changhai Hospital, Naval Medical University, Shanghai 200433, China)
出处
《国际麻醉学与复苏杂志》
CAS
2019年第6期544-548,共5页
International Journal of Anesthesiology and Resuscitation
关键词
呼气末二氧化碳分压
危险因素
呼吸抑制
低氧血症
End-tidal carbon dioxide partial pressure
Risk factors
Respiratory depression
Hypoxemia
