胸腹按压对无痛胃镜患者丙泊酚镇静引起呼吸抑制的预防

Chest or Abdominal Compression for Prevention of Respiratory Depression in Patients under Propofol Sedation during Gastroscopy

【目的】探讨胸部按压、腹部按压、胸腹联合按压对无痛胃镜患者丙泊酚镇静引起呼吸抑制的预防效果。【方法】筛选中山大学附属第三医院内镜中心行无痛胃镜的患者544例,随机分为4组,每组136例:C组(对照组)、T组(胸部按压组)、A组(腹部按压组)及T&A组(胸腹联合按压组),待患者给药意识消失后、胃镜检查实施前,T组、A组及T&A组分别给予胸部或(和)腹部按压:按压幅度(2~3)cm,频率30次/min,共20次。比较各组出现血氧下降(SpO_(2)<基础值)、低氧状态(SpO_(2)<95%)以及低氧血症(SpO_(2)<90%)的发生率;各组拔出胃镜行面罩通气率及B超下膈肌活动度变化情况。【结果】四组间血氧下降、低氧血症的发生率均有统计学差异(P<0.05);与C组比较,T组及A组血氧下降发生率明显降低(P<0.017);B超显示T组及T&A组的膈肌活动度均明显大于C组(P<0.01),其中以胸部按压组的膈肌活动度最大。【结论】胸部或腹部按压均能降低无痛胃镜中丙泊酚引起呼吸抑制的发生率,其中胸部按压组效果更显著。

【Objective】To explore the preventive effects of chest compression,abdominal compression and combined thoracoabdominal compression on propofol-induced respiratory depression during gastroscopy.【Methods】A total of 544 patients underwent propofol sedation during gastroscopy in our hospital were randomly divided into 4 groups(n=136 each):Group C(control group),Group T(chest compression group),Group A(abdominal compression group)and T&A(combined thoracoabdominal compression group).Altogether 20 chest,abdominal and combined thoracoabdominal compres⁃sions were started respectively on patients in Group T,A and T&A before performing gastroscopy and after unconscious⁃ness at a rate of 30 compressions per minute with a compression depth of 2~3 cm.The incidence of oxygen desaturation(SpO_(2)<baseline value),hypoxia(SpO_(2)<95%)and hypoxemia(SpO_(2)<90%)were compared among the groups.Incidence of gastroscope withdrawal and B-mode ultrasound assessment of diaphragm activity were observed.【Results】There were statistical differences in the incidence of oxygen desaturation and hypoxemia among the four groups(P<0.05).The inci⁃dence of oxygen desaturation in Group T and A were significantly lower than that in Group C(P<0.017).B-ultrasonogra⁃phy revealed that the diaphragm activity in Group T and T&A were significantly higher than that in Group C(P<0.01)and the patients in Group T had the highest diaphragm activity.【Conclusion】Both chest compression and abdominal com⁃pression can reduce the incidence of respiratory depression induced by propofol in patients during gastroscopy,and chest compression is more effective.