摘要
目的前瞻性评价托下颌试验在判定胃镜置入时麻醉深度的有效性。方法前瞻性选取2019年12月至2020年1月在首都医科大学附属北京友谊医院消化内镜中心行胃镜检查的509例患者作为研究对象,采用随机数字表法将患者分为对照组(n=252)和实验组(n=257)。对照组采用常规判断法判断麻醉深度,即在失去言语应答后尝试插入胃镜,实验组采用托下颌实验法判断麻醉深度,即在对下颌骨推力失去运动反应后尝试插入胃镜。评估两组患者胃镜置入条件,观察两组患者置入胃镜后出现阳性反应(置入1 min内有无体动、呛咳、恶心/呕吐、屏气等情况)的比例,记录操作时间和苏醒时间,记录操作过程中以及苏醒期间出现的麻醉相关不良反应,包括低血压、低氧血症、心动过缓、恶心呕吐、躁动及苏醒延迟等。结果实验组胃镜置入条件满意者高达89.9%,置入咽喉无阻力者高达93.0%,胃镜置入一次成功率高达96.9%,明显高于对照组(68.4%、78.1%、87.7%),差异均有统计学意义(P<0.05)。实验组置入胃镜后出现阳性反应的患者比例为12.7%,明显低于对照组(5.4%),异丙酚诱导剂量为(2.1±0.9)mg/kg,明显多于对照组(1.9±0.5)mg/kg,差异均有统计学意义(P<0.05)。两组患者操作时间,苏醒时间以及麻醉相关不良事件发生率比较,差异均无统计学意义(P>0.05)。结论托下颌实验法可作为评价无痛胃镜诊疗过程中胃镜置入时麻醉深度的有效方法。
Objective To observe the effect of jaw thrust on determining the depth of anesthesia in gastroscopy.Methods From December 2019 to January 2020,a total of 509 patients aged 18-65 years undergoing painless gastroscopy at the Department of Gastroenterology of Beijing Friendship Hospital,Capital Medical University were prospectively selected.Using a random number table Method,the patients were randomly divided into two groups:the control group(n=252)and the treatment group(n=257).In control group,the depth of anesthesia was evaluated by using the conventional approach.Specificly,insertion of the gastroscopy was attempted immediately after the loss of verbal contact.And in treatmentr group,the depth of anesthesia was evaluated by jaw thrust test.Insertion of the gastroscopy was attempted after the loss of motor response to a jaw thrust.Conditions for insertion of gastroscopy were assessed,positive reaction(having body moving,coughing,nausea and vomiting,breath holding and so on)1 minute after insertion of gastroscopy were observed,operation time,recovery time and adverse events related anesthesia(hypotension,hypoxemia,bradycardia,nausea,vomiting,restlessness,recovery delay and so on)during and after operation were all recorded between the two groups.Results In treatment group,the proportion of satisfactory conditions for insertion of gastroscopy was 89.9%,the percentage of patients inserted by gastroscopy without resistance was 93.0%,and the first time success rate of gastroscopy insertion was 96.9%,which were all higher than those in control group(68.4%,78.1%,87.7%,respectively),the differences were statistically significant(P<0.05).The proportion of patients in the experimental group who showed positive reactions after gastroscopy placement was 12.7%,which was significantly lower than that in the control group(5.4%),and the induction dose of propofol was(2.1±0.9)mg/kg,which was significantly higher than that in the control group(1.9±0.5)mg/kg,the differences were statistically significant(P<0.05).There were no sta
作者
侯海军
邵刘佳子
万磊
陶星
王拥军
刘缚鲲
薛富善
HOU Hai-jun;SHAO Liu-jia-zi;WAN Lei(Department of Anesthesiology,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)
出处
《临床和实验医学杂志》
2023年第11期1211-1214,共4页
Journal of Clinical and Experimental Medicine
基金
国家万人计划百千万人才工程领军人才专项基金项目(编号:W02060024)。
