新型异形鼻咽通气管在阻塞性睡眠呼吸暂停低通气综合征患者行无痛胃肠镜检查中的应用

Application of a new special-shaped nasopharyngeal catheter in painless gastroscopy in patients with OSAHS

目的探讨新型异形鼻咽通气管在阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者行无痛胃肠镜检查的安全性和有效性。方法选取2022-10至2023-03在空军特色医学中心门诊行无痛胃肠镜检查的OSAHS患者90例,随机分为对照组(C组)、鼻咽通气管1组(NPA1组)和鼻咽通气管2组(NPA2组)。C组采用氧气面罩吸氧,NPA1组和NPA2组采用鼻咽通气管,NPA2组同时监测PetCO_(2)。观察并比较各组一般情况、气道评估指标(Malampati分级)、无痛胃肠镜检查中低氧血症发生率、呼吸抑制发生率、辅助通气率、最低血氧饱和度、从低氧血症报警值到出现低氧血症的间隔时间。结果NPA1组呼吸抑制发生率(40.0%)低于C组(70.0%),NPA1组低氧血症发生率(23.3%)低于C组(50.0%),NPA1组辅助通气率(33.3%)低于NPA2组(46.7%)且低于C组(66.7%),NPA1组最低血氧饱和度[(92.93±3.60)%],高于C组的[(90.20±4.34)%],低于NPA2组的[(94.67±2.63)%],NPA2组从低氧血症报警值到低氧血症出现时间间隔[(63.25±10.28)s]长于NPA1组的[(22.14±4.10)s],差异均有统计学意义(P<0.05)。其中C组中有2例受试者因持续性低氧血症转入NPA1组,置入鼻咽通气管后SpO_(2)逐步恢复正常水平。结论新型异形鼻咽通气管较面罩吸氧可有效降低呼吸抑制和低氧血症发生率,提高OSAHS患者行无痛胃肠镜检查的安全性。联合PetCO_(2)监测可指导麻醉医师进行辅助通气处理,进一步降低呼吸抑制发生率,提升手术的安全性。

Objective To investigate the safety and efficacy of a new type of special-shaped nasopharyngeal catheter in patients with obstructive sleep apnea hypopnea syndrome(OSAHS)undergoing painless gastroscopy.Methods A total of 90 OSAHS patients who underwent painless gastroscopy examination in the outpatient department of Characteristics Medical Center of PLA Air Force from October 2022 to March 2023 were randomly divided into a control group(Group C),nasopharyngeal airway group 1(Group NPA1),and nasopharyngeal airway group 2(Group NPA2).Oxygen masks were used in Group C for oxygen inhalation,while NPA1 and NPA2 were given by nasopharyngeal catheter,and PetCO_(2)was monitored in group NPA2.The general condition,airway assessment indicators(Malampati classification),incidence of hypoxemia in painless gastroenteroscopy,incidence of respiratory depression,auxiliary ventilation rate,minimum oxygen saturation,and the interval time from hypoxemia alarm value to hypoxemia occurrence were observed and compared among the groups.Results The incidence of respiratory depression in Group NPA1(40.0%)was lower than that in Group C(70.0%).The incidence of hypoxemia in Group NPA1(23.3%)was lower than that in Group C(50.0%),and auxiliary ventilation rate in Group NPA1(33.3%)was lower than that in Group NPA2(46.7%)and lower than that in Group C(66.7%).The lowest blood oxygen saturation in Group NPA1[(9293±3.60)%]was higher than that of Group C[(90.20±4.34)%],and lower than that of Group NPA2[(94.67±2.63)%].The time interval between alarm value of hypoxemia and occurrence of hypoxemia in Group NPA2[(63.25±10.28)s]was longer than that in Group NPA1[(22.14±4.10)s],and the difference was statistically significant(P<005).In Group C,2 subjects were transferred to Group NPA1 due to persistent hypoxemia,and SpO_(2)gradually recovered to normal level after the placement of nasopharyngeal catheter.Conclusions The new special-shaped nasopharynx catheter can effectively reduce the incidence of respiratory depression and hypoxemia,and improve the safety of painless gastroscopy for OSAHS patients.Combined PetCO_(2)monitoring can guide anesthesiologists to conduct auxiliary ventilation treatment,further reduce the incidence of respiratory depression,and improve the safety of surgery.