无痛胃肠镜诊疗患者误吸预防策略查检表的构建及应用研究

Construction and application of a checklist for aspiration prevention strategies in painless gastrointestinal endoscopy diagnosis and treatment

目的构建无痛胃肠镜诊疗患者误吸预防策略查检表(以下简称查检表),并评价其应用效果。方法基于文献证据和临床资料分析结果,构建无痛胃肠镜诊疗误吸预防策略查检表。采用编制的查检表对2021年7月-12月在浙江省某三级甲等医院内镜中心行无痛胃肠镜诊疗的患者进行临床观察,将2021年1月-6月行无痛胃肠镜诊疗的患者作为对照组,比较查检表应用前后无痛胃肠镜诊疗患者低氧血症发生率及持续时间、需要紧急气道管理的患者比例、不良事件发生率和患者及医疗团队满意度等。结果本研究共进行了2轮专家咨询,编制的查检表包含9个条目,2轮专家意见肯德尔协调系数分别为0.715和0.730。使用查检表后,行无痛胃肠镜诊疗患者低氧血症发生率显著降低,低氧血症持续时间减少,且显著降低了需要紧急气道处理的患者比例;患者发生误吸或严重喉痉挛需要药物辅助治疗的发生率降低,前后比较差异具有统计学意义(P<0.05)。结论应用无痛胃肠镜诊疗误吸预防策略查检表,有助于落实胃肠镜诊疗中误吸的预防措施,有利于保障无痛胃肠镜诊疗患者的医疗安全。

Objective To construct and evaluate a checklist for aspiration prevention strategies for painless gastrointestinal endoscopy diagnosis and treatment.Methods Based on the evidence from the literature and the clinical data analysis,we constructed aspiration prevention strategies checklist for painless gastrointestinal endoscopy diagnosis and treatment.The checklist was used to clinically observe patients who underwent painless gastrointestinal endoscopy in our center from July to December 2021.The incidence and duration of hypoxemia in patients with painless gastrointestinal endoscopy,the proportion of patients requiring emergency airway management,the incidence of adverse events,patient satisfaction and medical team satisfaction were compared before and after the application of the checklist.Results Thereweretwo rounds of expert consultation inthis study.The checklist for aspiration prevention strategy of painless gastrointestinal endoscopy diagnosis and treatment included 9 items,and the W coordination coefficients of the two rounds of expert opinion were 0.715 and 0.730 respectively After using the checklist,the incidence of hypoxemia was significantly reduced in patients undergoing painless gastrointestinal endoscopy,the duration of hypoxemia was reduced.The ratio of patients requiring emergency airway management was significantly reduced.The incidence of aspiration or severe laryngospasm requiring drug adjuvant therapy decreased,and the differences were statistically significant(P<0.05).Conclusion The application of the checklist can improvethe implementation of aspiration prevention measures in the diagnosis and treatment of painless gastrointestinal endoscopy.It is conducive to improve the medical safetyof patients with painless gastrointestinal endoscopy.