一套无痛消化内镜麻醉管理模式的临床观察

A standardized management model of anesthesia for painless digestive endoscopy

目的评价无痛消化内镜麻醉管理模式的安全性和可行性。方法对采用麻醉医生指导的护士约诊、术中协助、术后苏醒观察的麻醉管理模式下施行的17100例无痛消化内镜诊疗患者的病例资料进行回顾性分析，统计严重不良反应及并发症发生情况，并于所有病例中按病历编号随机抽取800例，胃镜组、肠镜组、EUS组、ERCP组患者各200例，统计各组内镜诊疗时间、入睡时间、苏醒时间、离科时间以及并发症发生情况。结果17100例中发生严重不良反应者10例（0．058％），包括呼吸暂停3例，缩颌、舌后坠致上呼吸道梗阻1例，进镜时喉痉挛5例，经口肠梗阻导管置入术中反流误吸1例；无一例与麻醉及内镜诊疗相关的死亡病例。800例抽样结果显示，术中平均动脉压升高或降低超过基础值30％、心率加快或减慢超过基础值30％、血氧饱和度〈95％的发生率分别在6．0％～25．0％、3．0％～8．5％、≤2．0％；术中遗忘率在99％～100％，睡眠质量好发生率在98．O％～100．0％；术中呛咳发生率在0．5％～4．5％，体动发生率在5．5％～11．5％，肌阵挛发生率在1．5％～3．5％；术后恶心呕吐、兴奋、躁动、眩晕发生率均不高于4％。结论采用麻醉医生指导的护士约诊、术中协助、术后苏醒观察的麻醉管理模式是安全和可行的，有利于提高麻醉效能，减少并发症。

Objective To evaluate the safety and feasibility of the standardized management model of anesthesia for painless digestive endoscopy. Methods Data of 17 100 patients who underwent painless endoscopy were reviewed for severe adverse reaction and complications. The model included anaesthetist-di- rected appointment, nurse assistance during operation, and postoperative nurse observation. Eight hundred cases （200 of gastric endoscopy, intestinal endoscopy, EUS and ERCP respectively） were randomly selected and analyzed for times of endoscopic diagnosis, anesthesia, wakening and discharge, and complications. Re- suits Of the 17 100 cases, severe complications occurred in 10 （0. 058% ） , including 3 apnea, one respir- atory obstruction due to opisthognathism and glossoptosis, five larygneal spasm and 1 reflux inspiration. There was no anesthesia or endoscopy related death. Study of 800 cases showed intraoperative MAP, HR in- crease or decrease over 30% of the baseline, the incidence of SpO： 〈95% were 6. 0% ~25.0% , 3.0% - 8. 5%, ~〈2. 0%, respectively. The rate of lethe, good quality of sleep were 99% - 100% and 98. 0% -100. 0%, respectively. The rates of cough, body movement and myoclonic were 0. 5% ~ 4. 5%, 5.5% - 11.5 % , and 1.5% -3.5% , respectively. Rates of nausea and vomiting, excitement, restlessness and diz- ziness were lower than 4%. Conclusion The standardized management model, feasible, safe and effective, is able to facilitate anesthetic efficacy and reduce complications.