实用老年医学

实用老年医学 ›› 2022, Vol. 36 ›› Issue (12): 1242-1246.doi: 10.3969/j.issn.1003-9198.2022.12.014

• 临床研究 • 上一篇    下一篇

快充式经鼻湿化高流量通气在老年病人无痛胃镜联合结肠镜检查中的应用效果

曹媛媛, 丁可, 赵秀秀, 徐漫, 胡静, 方兆晶   

  1. 210006 南京医科大学附属南京医院(南京市第一医院)麻醉科
  • 收稿日期:2022-02-08 出版日期:2022-12-20 发布日期:2022-11-30
  • 通讯作者: 方兆晶,Email: fangzhaojing1988@163.com
  • 基金资助:
    南京医科大学科技发展基金资助项目(NMUB2019160)

Effects of transnasal humidified rapid-insufflation ventilatory exchange in the elderly patients receiving painless gastroscopy combined with colonoscopy

CAO Yuan-yuan, DING Ke, ZHAO Xiu-xiu, XU Man, HU Jing, FANG Zhao-jing   

  1. Department of Anesthesiology,Nanjing First Hospital,Nanjing Medical University,Nanjing 210006,China
  • Received:2022-02-08 Online:2022-12-20 Published:2022-11-30

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摘要： 目的 观察快充式经鼻湿化高流量通气(THRIVE)在老年病人无痛胃镜联合结肠镜检查中的应用效果。 方法 选择拟行无痛胃镜联合结肠镜检查病人120例,年龄65~79岁,ASA Ⅰ~Ⅲ级,Mallampatti分级 Ⅰ~Ⅱ,采用随机数表法分为鼻导管吸氧组(C组)和高流量吸氧组(T组)(n=60)。采用国际镇静工作组流程记录检查中与缺氧相关的不良事件以及处理措施;记录与缺氧无关的不良事件,包括无意识肢体运动、恶心呕吐、呛咳、鼻咽部不适、气道损伤、气压伤等;记录2组病人麻醉前(T0)、插入胃镜后(T1)及苏醒时(T2)的血流动力学水平;记录丙泊酚用量、瑞芬太尼用量、检查时间与苏醒时间;记录麻醉医生、内镜操作者及病人满意度。 结果 与C组相比,T组围术期缺氧、托下颌、面罩加压给氧、鼻咽通气道置入、无意识肢体运动发生率明显降低(P<0.05),丙泊酚用量增加(P<0.05),麻醉医生、内镜操作者及病人满意度明显提高(P<0.05),各时间点血流动力学水平、瑞芬太尼用量、检查时间和苏醒时间差异无统计学意义(P>0.05),2组均无气压伤及气道损伤发生。 结论 THRIVE可安全有效地改善老年病人无痛胃镜联合结肠镜检查中氧合,减少术中体动,从而提高手术安全性及医患满意度。

关键词: 快充式经鼻湿化高流量通气, 胃镜, 结肠镜, 老年人

Abstract: Objective To observe the efficacy and safety of transnasal humidified rapid insufflation ventilatory exchange (THRIVE) in the elderly patients receiving painless gastroscopy combined with colonoscopy. Methods One hundred and twenty patients who need painless gastroscopy combined with colonoscopy, aged 65-79 years old, with an American Society of Anesthesiologists physical status of Ⅰ-Ⅲ, with body mass index of 18-28, with a Mallampatti of Ⅰ or Ⅱ, were divided into two groups (n=60) using a random number table method, nasal catheter oxygen inhalation group (group C) and THRIVE group (group T). The adverse reactions and treatments related to hypoxia during operation were recorded according to the procedure of Society of Intravenous Anaesthesia (SIVA). The other adverse events including involuntary limbs swing, choking cough, vomiting, airway injury and air pressure injury were recorded as well. The levels of the hemodynamic index of the patients before anesthesia (T0), after insertion of the gastroscope (T1), and at the time of awaking (T2) were recorded. The operation time, recovery time, total dose of propofol and remifentanil, satisfaction of the anesthesiologists, operators and the patients were recorded after the operation. Results Compared with group C, the incidence rates of SpO2<95%, jaw-lift, pressured mask, inserted asopharyngeal airway and involuntary limbs swing in group T were significantly decreased(P<0.05), and the dosage of propofol was increased (P<0.05), and the satisfaction of the anesthesiologists, operators and the patients was significantly improved (P<0.05).The levels of hemodynamic index, the dose of remifentanil, the operation and recovery time showed no significant differences between the two groups (P>0.05). No patients presented with airway injury or air pressure injury in both groups. Conclusions THRIVE can maintain the oxygenation in the elderly patients receiving painless gastroscopy combined with colonoscopy more safely and effectively, reducing the incidence of the involuntary limbs swing and improving the satisfaction of the doctors and patients.

Key words: transnasal humidified rapid insufflation ventilatory exchange, gastroscopy, colonoscopy, aged

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