无痛胃肠镜检查中不良事件及其相关影响因素

Analysis of adverse events and related influencing factors in painless gastrointestinal endoscopy

目的探讨无痛胃肠镜检查中不良事件及其相关影响因素。方法采用电子问卷形式在新青年麻醉论坛和medical group上发布问卷调查,选取的调查时间与人群范围为2021年3月至5月在华中地区各级含消化内镜中心的综合医院内从事无痛胃肠镜检查工作≥12个月的麻醉医生和内镜医生。结果全身麻醉下行无痛胃肠镜检查中发生低血压(P<0.001)、心律失常(P=0.034)、氧饱和度<85%(P<0.001)、呼吸抑制(P<0.001)和反流误吸(P=0.023)的比例明显高于清醒镇静下行无痛胃肠镜检查。在这些高发不良事件中,患者高龄(OR=1.13,95%CI:0.03~1.61,P=0.009)、肥胖(OR=10.93,95%CI:1.30~92.07,P=0.028)、合并症多(OR=4.14,95%CI:1.28~13.40,P=0.018)、内镜医生操作不熟练(OR=6.23,95%CI:1.55~24.95,P=0.010)及麻醉医生给药剂量大(OR=2.77,95%CI:1.03~7.43,P=0.043)会显著增加不良事件发生频率,而麻醉医生给药缓慢(OR=0.22,95%CI:0.07~0.63,P=0.005)会降低不良事件发生频率。结论尽管应用异丙酚镇静全身麻醉下行无痛胃肠镜检查的风险较清醒镇静更大,但该方法具有检查后恢复迅速及检查中操作中断率和误诊率低等优点,可确保无痛胃肠镜检查的安全性及舒适性。

Objective To explore the adverse events and related factors during painless gastrointestinal endoscopy.Methods The survey was completed on New Youth Anesthesia Forum and Medical Group in the form of an electronic questionnaire,and was administered to anesthesiologists and endoscopists who had been engaged in painless gastrointestinal endoscopy for≥12 months in general hospitals,including digestive endoscopy centers in central China between March 2021 and May 2021.Results The proportion of hypotension(P<0.001),arrhythmia(P=0.034),oxygen saturation<85%(P<0.001),respiratory depression(P<0.001),and reflux aspiration(P=0.023)that occurred during painless gastrointestinal endoscopy under general anesthesia was significantly higher than that of painless gastrointestinal endoscopy under conscious sedation.For frequently occurring adverse events,older age(OR=1.13,95%CI:0.03-1.61,P=0.009),obesity(OR=10.93,95%CI:1.30-92.07,P=0.028),additional comorbidities(OR=4.14,95%CI:1.28-13.40,P=0.018),an unskilled endoscopist(OR=6.23,95%CI:1.55-24.95,P=0.010),or high dose of anesthetics(OR=2.77,95%CI:1.03-7.43,P=0.043)significantly increased the frequency of adverse events,while slow administration of anesthetics reduced the frequency of adverse events.Conclusion Although the use of general anesthesia under propofol sedation has a greater potential risk than conscious sedation,the comfort that patients feel,rapid recovery after surgery,and low probability of interruption or failure during the operation cannot be ignored.Therefore,anesthesiologists must ensure the safety of the operation and provide further expertise in the immediate management of the respiratory system to better protect the safety of their patients.