无痛胃镜中呼吸管理的最佳给氧模式探讨

A safe and simple oxygen inhalation model during painless gastroscopy

目的探讨无痛胃镜检查中的最佳呼吸管理模式。方法 200例无痛胃镜病人,采用丙泊酚与芬太尼复合静脉镇痛,按随机数字法分为4组,每组50例。Ⅰ组,深呼吸预处理+吸氧面罩2-3 L/min给氧;Ⅱ组,深呼吸预处理+吸氧面罩4-5 L/min给氧;Ⅲ组,深呼吸预处理+鼻导管4-5 L/min给氧;Ⅳ组,鼻导管4-5 L/min给氧。记录病人麻醉前,麻醉后2,5,10 min时的呼吸次数和SpO2,记录呼吸抑制情况。结果麻醉后所有病人呼吸频率均较麻醉前显著降低(P<0.05),10min后呼吸频率恢复至麻醉前水平。Ⅳ组SpO2麻醉后2 min显著降低(P<0.05),Ⅲ组SpO2麻醉后2 min也明显降低(P<0.05),但下降幅度低于Ⅳ组;而Ⅰ、Ⅱ组麻醉前后SpO2变化差异无统计学意义(P>0.05),即深呼吸预处理组SpO2显著高于未深呼吸预处理的Ⅳ组(P<0.05)。深呼吸预处理组无低氧血症的发生,与未深呼吸预处理的Ⅳ组(6/50)有显著差异(P<0.05)。结论深呼吸预处理联合吸氧面罩2-3 L/min给氧是无痛胃镜检查过程中安全、有效、简便的给氧模式。

Objective To explore the best ventilation way during the painless gastroscopy.Methods A total of 200 patients with venous compound anesthesia of propofol and fentanyl for painless gastroscopy,were randomized into four groups：group Ⅰ（deep breathing pretreatment＋2-3 L/min oxygen flow with inhalation mask）;group Ⅱ（deep breathing pretreatment ＋ 4-5 L/min oxygen flow with inhalation mask）;group Ⅲ（deep breathing pretreatment ＋ 4-5 L/min oxygen flow with nasal tube）;group Ⅳ（4-5 L/min oxygen flow with nasal tube）.The respiratory rate and pulse oxygen saturation（SpO2）of patients were recorded before anesthesia,2,5,10 min after anesthesia.Results Respiratory rate of all patients was decreased significantly after anesthesia（P0.05）,and returned to the normal at 10 min after anesthesia.SpO2 was decreased significantly 2 min after anesthesia in group Ⅳ and group Ⅲ（P0.05）.SpO2 in group Ⅰand groupⅡ was not significantly different before and after anesthesia（P0.05）.SpO2 was higher in groups Ⅰ-Ⅲ than that in group Ⅳ（P0.05）.The incidence of hypoxemia was significantly lower in group Ⅰ-Ⅲ than that in group Ⅳ（P0.05）.Conclusion Oxygen inhalation through a inhalation mask at a speed of 2-3 L/min during the painless gastroscopy is a safe,effective and simple procedure for oxygen supply.