摘要
目的比较魏氏鼻咽通气道(Wei nasal jet tube,WNJT)与无创鼻导管吸氧对实施丙泊酚镇静无痛胃镜检查患者血流动力学的影响,探讨WNJT在丙泊酚镇静无痛胃镜检查中的应用价值。方法180例实施丙泊酚镇静无痛胃镜检查的患者,随机分为WNJT组90例和鼻导管组90例,观察2组镇静前(T0)、镇静后(T1)和插入通气装置后(T2)的收缩压、平均动脉压(mean arterial pressure,MAP)和心率,比较2组T1、T2时收缩压、MAP和心率的差值(△收缩压T2—T1、△MAPT2—T1、△心率T2—T1);比较2组高血压、低血压、心动过速、心动过缓等不良心血管事件发生情况及麻黄碱使用情况;观察2组通气装置所致鼻出血和术后咽痛发生情况及胃镜检查中最低脉搏血氧饱和度(pulse oxygen saturation,SpO2)。结果T0时,2组收缩压、MAP、心率比较差异均无统计学意义(P>0.05);WNJT组T2时收缩压[(103.3±12.4)mm Hg]和MAP[(75.9±9.6)mm Hg]高于T1时[(99.4±13.2)、(73.4±10.4)mm Hg](P<0.05),心率[(73.1±9.6)次/min]与T1时[(72.4±11.0)次/min]比较差异无统计学意义(P>0.05);鼻导管组T2时收缩压、MAP和心率与T1时比较差异均无统计学意义(P>0.05);2组T1、T2时收缩压、MAP、心率均低于T0时(P<0.05);WNJT组△MAPT2—T1[2.7(0.6,5.7)mm Hg]和△心率T2—T1[1.0(—0.3,2.0)次/min]高于鼻导管组[1.5(—3.1,4.4)mm Hg,—1.0(—4.0,1.0)次/min],△收缩压T2—T1[3.0(1.0,7.5)mm Hg]与鼻导管组[1.0(-3.0,6.3)mm Hg]比较差异无统计学意义(P>0.05);2组胃镜检查中高血压、低血压、心动过速、心动过缓、总体不良心血管事件、鼻出血发生率和麻黄碱使用比率及术后咽痛发生率比较差异均无统计学意义(P>0.05),WNJT组胃镜检查中最低SpO2[(97.6±1.7)%]高于鼻导管组[(94.0±5.3)%](P<0.05)。结论WNJT给氧可安全用于丙泊酚镇静无痛胃镜检查,具有一定程度的循环功能改善作用,不增加不良心血管事件发生率。
Objective To compare the influences of Wei nasal jet tube(WNJT)and non-invasive nasal cannula oxygen supplementation on hemodynamics of patients undergoing painless gastroscopy with propofol sedation,and to investigate the value of WNJT.Methods A total of 180 patients scheduled for painless gastroscopy with propofol sedation were randomly and equally divided into WNJT group and nasal cannula group.The systolic blood pressure(SBP),mean arterial pressure(MAP)and heart rate(HR)were observed before sedation(T0),after sedation(T1)and immediately after inserting WNJT or nasal cannula(T2).The difference-values of SBP,MAP and HR at T2 and T1 were calculated and compared between two groups.The incidences of adverse cardiovascular events including hypertension,hypotension,tachycardia and bradycardia as well as the use of ephedrine were compared between two groups.The occurrence of epistaxis induced by the studied devices,postoperative sore throat and minimal pulse oxygen saturation(SpO2)during gastroscopy were also assessed.Results SBP,MAP and HR at T0 showed no significant differences between two groups(P>0.05).In WNJT group,SBP and MAP were higher at T2((103.3±12.4),(75.9±9.6)mm Hg)than those at T1((99.4±13.2),(73.4±10.4)mm Hg)(P<0.05),and HR showed no significant difference at T2((73.1±9.6)beat/min)from that at T1((72.4±11.0)beat/min)(P>0.05).In nasal cannula group,SBP,MAP and HR at T1 and T2 did not change significantly(P>0.05).SBP,MAP and HR were lower at T1 and T2 than those at T0(P<0.05).△MAPT2-T1and△HRT2—T1 were higher in WNJT group(2.7(0.6,5.7)mm Hg,1.0(-0.3,2.0)beat/min)than those in nasal cannula group(1.5(-3.1,4.4)mm Hg,-1.0(-4.0,1.0)beat/min)(P<0.05),and there was no significant difference in△SBPT2—T1 between two groups(3.0(1.0,7.5)mm Hg vs.1.0(-3.0,6.3)mm Hg)(P>0.05).There were no significant differences in the incidences of hypertension,hypotension,tachycardia,bradycardia,total adverse cardiovascular events,postoperative sore throat and epistaxis,as well as the use of ephedrine between two gr
作者
邵刘佳子
万磊
刘缚鲲
洪方晓
薛富善
SHAO Liu-Jia-zi;WAN Lei;LIU Fu-kun;HONG Fang-xiao;XUE Fu-shan(Department of Anesthesiology,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)
出处
《中华实用诊断与治疗杂志》
2021年第6期610-613,共4页
Journal of Chinese Practical Diagnosis and Therapy
基金
中华医学会消化内镜学分会麻醉协作组“人福”科研基金(CSDE022020090001)
北京市属医院科研培育项目(PX2019001)
北京市医院管理局“青苗”计划专项经费资助项目(QML20190101)。
关键词
胃镜
魏氏鼻咽通气道
鼻导管吸氧
血流动力学
丙泊酚
gastroscopy
Wei nasal jet tube
nasal cannula oxygen supplementation
hemodynamics
propofol
