心率变化与触碰睫毛作为无痛胃镜入镜点的比较

Heart-rate changes vs eyelash-touching for timing the device insertion in painless gastroscopy

目的:以胃镜检查者心率上升至最高及回落平稳后,与触碰患者睫毛作为胃镜入镜点对比,观察患者不良事件及检查过程中生命征。方法:选择本院2018年1月至2018年7月90位门诊无痛胃镜患者,随机、双盲分成3组。H组为静脉推注异丙酚后心率上升至最高点时插入胃镜,L组为静脉推注异丙酚后心率达高点后回落至静推异丙酚之前相当水平时插入胃镜,C组以胃镜操作者间断触碰患者睫毛,视其无眨眼动作时插入胃镜。记录患者开通外周静脉前(T0),静脉推注异丙酚之前(T1),静脉推注异丙酚之后2分钟(T2)和胃镜离开患者口腔(T3)的平均动脉压(MAP)、心率(HR)和脉搏氧饱和度(SPO2)。记录胃镜置入期间如下不良事件:呛咳,体动,脉搏氧饱和度降至93%以下。记录托下颌及追加异丙酚干预措施。结果:T2时,C组MAP明显低于H组和L组(P<0.05),C组SPO2明显低于H组和L组(P<0.05)。MAP在T2时L组和C组下降(P<0.05),且在C组下降明显。H组和L组呛咳、体动及SPO2≤93%、追加药物及托下颌干预事件相当,且均明显少于C组(P<0.05)。结论:以心率作为无痛胃镜入镜点较以触碰患者睫毛不良事件少,干预措施少,且在患者心率最高点时入镜,患者生命征较平稳。

Objective:To compare the adverse events and changes in vital signs during gastroscopy with device insertion determined by heart rate peaking or post-peak recovery versus eyelash touching.Methods:A total of 90 outpatients scheduled for painless gastroscopy in our hospital between January 2018 and July 2018 were divided into three groups as per randomized double-blind protocol.In the group H,gastroscope was inserted at the heart rate peaking after intravenous propofol use;in the group L,gastroscope was inserted when the heart rate resumed baseline after peaking induced by intravenous propofol use;in the group C,gastroscope was inserted at the loss of eyelash reflex determined by intermittent eyelash touch.The mean arterial pressure(MAP),heart rate(HR)and pulse oxygen saturation(SpO2)were recorded before establishment of venous access(T0),before intravenous bolus of propofol(T1),2 minutes after the propofol bolus(T2),and after extraction of gastroscope from the mouth(T3).Adverse events during gastroscopy,including cough,body movement,and SpO2 decline to below 93%,were recorded;so were the need for mandible holding and additional use of propofol.Results:At T2,the MAP and SpO2 were significantly lower in group C than those in groups H and L(P<0.05).At T2,there was a significantly decrease in MAP from baseline in groups L and C(P<0.05),and the decrease was greater in group C.In groups H and L,the incidence of cough,body movement and SpO2≤93%,as well as the need for mandible holding and additional propofol use did not differ between each other,but were significantly less compared with group C(P<0.05).Conclusion:Compared with eyelash touching,using heart rate changes for timing the device insertion in painless gastroscopy may result in fewer adverse events and less need for additional interventions.Moreover,the vital signs can be more stable with the gastroscope inserted at the peaking of heart rate.