经口声门上导管通气用于肥胖患者无痛胃镜手术的临床观察

Clinical observation of oral supraglottic catheter ventilation for painless gastroscopy in obese patients

目的探讨经口声门上导管通气用于肥胖患者无痛胃镜手术的有效性和安全性。方法将兵器工业五二一医院2020年6~12月60例行无痛胃镜手术的肥胖患者采用数字表法随机分为观察组和对照组,每组各30例。两组先静脉注射舒芬太尼0.1μg/kg,接着注射依托咪酯丙泊酚混合液0.15~0.20ml/kg。待睫毛反射消失后,观察组经口置入声门上导管,然后开始行胃镜手术。对照组则为鼻导管通气。观察两组麻醉前(T_(0))、插入胃镜前(T_(1))、插入胃镜后10min(T_(2))及手术结束时(T_(3))的MAP、HR、SpO_(2)。采集两组T_(2)时的动脉血行血气分析。记录两组术中呼吸抑制和面罩加压给氧情况。结果T_(1)、T_(2)时对照组SpO_(2)分别为(93.6±3.3)%和(93.5±4.6)%,低于T_(0)时的(99.5±0.6)%,且低于观察组的(99.4±0.7)%和(99.8±0.3)%,差异有统计学意义(P<0.05)。T_(2)时观察组PaO_(2)为(316.5±27.7)mmHg(1mmHg=0.133kPa),高于对照组的(135.4±46.3)mmHg,差异有统计学意义(P<0.05);PaCO_(2)和AaDpO_(2)分别为(38.6±3.5)mmHg和(11.6±2.4)mmHg,低于对照组的(51.4±5.7)mmHg和(16.5±3.6)mmHg,差异有统计学意义(P<0.05)。观察组呼吸抑制和面罩加压给氧的比例分别为6.7%和0,分别低于对照组的36.7%和20.0%,差异有统计学意义(P<0.05)。结论经口声门上导管通气用于肥胖患者行无痛胃镜手术,可有效改善患者缺氧,并避免二氧化碳潴留,使胃镜手术更安全。

Objective To investigate the efficacy and safety of oral supraglottic catheter ventilation in painless gastroscopy in obese patients.Methods A total of 60 obese patients who underwent painless gastroscopy in our hospital from June to December 2020 were randomly divided into observation group and control group,with 30 cases in each group.The two groups were injected with sufentanil 0.1μg/kg,then 0.15~0.20ml/kg etomidate propofol mixture was injected.After the eyelash reflex disappeared,the observation group placed an supraglottic catheter through the mouth,and then began gastroscopy.The control group was nasal catheter ventilation.MAP,HR and SpO_(2) were observed before anesthesia(T_(0)),before gastroscope insertion(T_(1)),10minutes after gastroscope insertion(T_(2))and at the end of operation(T_(3)).The arterial blood of the two groups at T_(2) was collected for blood gas analysis.Respiratory depression and mask pressurized oxygen were recorded between two groups.Results SpO_(2) in the control group at T_(1) and T_(2) were(93.6±3.3)%and(93.5±4.6)%respectively,were lower than(99.5±0.6)%at T_(0),and lower than(99.4±0.7)%and(99.8±0.3)%in the observation group,the difference was significant(P<0.05).At T_(2),PaO_(2) in the observation group was(316±27)mmHg(1mmHg=0.133kPa),which was higher than(135±46)mmHg in the control group the difference was significant(P<0.05);PaCO_(2) and AaDpO_(2) were(38±3)mmHg and(11±2)mmHg,respectively,lower than(51±5)mmHg and(16±3)mmHg in the control group the difference was significant(P<0.05).The proportions of respiratory inhibition and mask pressurized oxygen in the observation group were 6.7%and 0,respectively,lower than 36.7%and 20.0%in the control group(P<0.05).Conclusion Oral supraglottic duct ventilation for painless gastroscopy in obese patients can effectively improve hypoxia,avoid carbon dioxide retention,and make gastroscopy safer.