摘要
目的观察快充式经鼻湿化高流量通气(THRIVE)对结直肠息肉无痛内镜下黏膜切除(EMR)术患者胃进气和SpO_(2)的影响。方法选择行无痛结直肠息肉EMR术患者70例,男36例,女34例,年龄18~64岁,BMI 18~25 kg/m^(2),ASAⅠ或Ⅱ级。采用随机数字表法将患者分为两组:高流量吸氧组(T组)和常规吸氧组(C组),每组35例。T组给予THRIVE,C组经鼻常规吸氧,麻醉期间维持BIS 50~65。采用床旁胃超声观察患者的胃内容和胃进气。记录术前平卧位下静息5 min(静息5 min)、进镜后1 min、进镜至回盲瓣时和术毕时的HR、SpO_(2),静息5 min、进镜至回盲瓣和术毕时的PaCO_(2)、PaO_(2)和pH,静息5 min和术毕时胃进气和饱胃发生情况、胃窦部横截面积(CSA)。记录麻醉期间轻度低氧、中度低氧、重度低氧的发生情况。记录手术时间、术中丙泊酚用量、瑞芬太尼给药次数、PACU停留时间和术中输液量,低血压、高血压、心动过缓、反流误吸、术后恶心呕吐等不良反应发生情况,消化科内镜医师和患者满意度评分。结果与C组比较,T组进镜后1 min时SpO_(2)明显升高(P<0.05),进镜至回盲瓣和术毕时PaCO_(2)明显降低(P<0.05),轻度低氧和中度低氧发生率明显降低(P<0.05)。两组静息5 min和术毕时均未出现胃进气阳性和饱胃。两组不良反应发生率和患者满意度评分差异无统计学意义。T组内镜医师满意度评分明显高于C组(P<0.05)。结论与常规鼻导管吸氧比较,THRIVE不会引起高碳酸血症,不影响胃进气和胃内容,可以降低无痛EMR术患者轻中度低氧的发生,不增加反流误吸的风险,消化科内镜医师满意度更高。
Objective To observe the effects of transnasal humidified rapid-insufflation ventilatory exchange(THRIVE)on gastric air intake and SpO_(2) in patients with painless endoscopic mucosal resection(EMR)of colorectal polyps.Methods Seventy patients with painless colorectal polyps EMR,36 males,34 females,aged 18-64 years,BMI 18-25 kg/m^(2),ASAⅠorⅡ.The patients were divided into two groups:high-flow oxygen inhalation group(group T)and conventional oxygen inhalation group(group C)by random number table method,35 cases in each group.Patients in group T were given THRIVE oxygen inhalation,and patients in group C were routinely inhaled oxygen through the nose.During anesthesia,the BIS value was maintained at 50-65.Bedside gastric ultrasonography was used to observe the gastric content and gastric air intake of patients.The HR and resting SpO_(2) in the supine position were recorded 5 minutes before the surgery(rest for 5 minutes),1 minute after entering the endoscope,when entering the endoscope to the ileocecal valve,and at the end of the surgery.The PaCO_(2),PaO_(2) and pH values were recorded 5 minutes before surgery,when entering the endoscope to the ileocecal valve,and at the end of the surgery,so were gastric intake and satiety,and antral cross-sectional area(CSA)for 5 minutes before surgery and after surgery.The occurrence of mild,moderate,and severe hypoxia during anesthesia were recorded.The operation time,the amount of propofol used during the operation,the number of dosage times of remifentanil,PACU residence time,and infusion during surgery,the occurrence of adverse reactions such as hypotension,hypertension,bradycardia,reflux aspiration,postoperative nausea and vomiting,and the satisfaction score of digestive endoscopy physicians and patients were recrded.Results Compared with group C,SpO_(2) in group T was significantly increased 1 minutes after entering the endoscope(P<0.05),and PaCO_(2) was significantly decreased at the time of entering the endoscope to the ileocecal valve and the end of the surgery(P<0.
作者
程丹
谭其莲
蒋宇智
蒋卫清
陈利海
郭姚邑
姜帆
冯悦
斯妍娜
CHENG Dan;TAN Qilian;JIANG Yuzhi;JIANG Weiqing;CHEN Lihai;GUO Yaoyi;JIANG Fan;FENG Yue;SI Yanna(Department of Anesthesiology,Perioperative and Pain Medicine,Nanjing Hospital Affiliated to Nanjing Medical University(Nanjing First Hospital),Nanjing 210000,China)
出处
《临床麻醉学杂志》
CAS
CSCD
北大核心
2023年第11期1152-1157,共6页
Journal of Clinical Anesthesiology
基金
南京市医学科技发展资金资助(QRX17019,YKK18105)
南京市卫生科技发展专项资金重点项目(ZKX22030)
江苏省六大人才高峰项目(WSW-106)。
关键词
内镜下黏膜切除术
镇静镇痛
快充式经鼻高流量通气
胃进气
低氧
Endoscopic mucosal resection
Sedation and analgesia
Transnasal humidified rapid-insufflation ventilatory exchange
Gastric intake
Hypoxia
