经鼻湿化高流量通气在肥胖患者无痛胃镜检查中的应用效果

Application effect of transnasal humidified rapid insufflation ventilatory exchange on painless gastroscopy in obese patients

目的观察经鼻湿化高流量通气(THRIVE)在肥胖患者无痛胃镜检查中的应用效果。方法选择接受无痛胃镜检查的肥胖患者100例,男65例,女35例,年龄18~64岁,BMI≥30 kg/m^(2),ASAⅠ或Ⅱ级。随机分为两组:THRIVE组(T组)和对照组(D组),每组50例。T组通过经鼻湿化高流量通气装置吸纯氧20 L/min,D组经鼻导管吸纯氧8 L/min。静脉注射丙泊酚1.5~2.0 mg/kg,待患者意识丧失、睫毛反射消失、肌肉松弛后开始进镜。T组在患者意识消失后将氧流量调整为70 L/min,D组保持吸入氧流量不变。记录低氧血症发生情况、低氧血症持续时间和最低SpO_(2)。记录胃镜检查期间呼吸支持(包括托下颌、面罩辅助通气以及气管插管行机械通气)情况和一次胃镜检查成功情况。记录胃镜检查期间呛咳和体动发生情况、检查时间。记录患者、胃镜操作者和麻醉科医师满意情况。结果T组未发生低氧血症,D组低氧血症发生率为22%,低氧血症持续时间为(45.6±14.1)s。与D组比较,T组最低SpO_(2)明显升高(P<0.05),胃镜检查期间需要托下颌和面罩加压辅助通气的所占比例明显降低(P<0.05),一次胃镜检查成功率明显升高(P<0.05),胃镜检查期间呛咳及体动反应发生率明显降低(P<0.05),检查时间明显缩短(P<0.05),患者、胃镜操作者与麻醉科医师满意度明显提高(P<0.05)。结论经鼻湿化高流量通气在肥胖患者无痛胃镜检查术中可以有效预防低氧血症的发生,提高了患者、胃镜操作者和麻醉科医师三方满意度。

Objective To observe the efficacy of transnasal humidified rapid insufflation ventilatory(THRIVE)on painless gastroscopy in the obese patients.Methods One hundred obese patients who needed painless gastroscopy were selected,including 65 males and 35 females,aged 18-64 years,BMI≥30 kg/m^(2),ASA physical statusⅠorⅡ.They were randomly divided into two groups:THRIVE group(group T)and control group(group D),50 patients in each group.In group T,the pure oxygen was inhaled through nasal humidification high flow ventilation device for 20 L/min.In group D,the pure oxygen was inhaled through the nasal catheter for 8 L/min.After intravenous injection of propofol 1.5-2.0 mg/kg was given,and began to enter the lens when the patients loss of consciousness,disappearance of eyelash reflex and muscle relaxation.The oxygen flow in group T was adjusted to 70 L/min after the loss of consciousness in group D to keep the inhaled oxygen flow unchanged.The occurrence rate of hypoxemia,the time of duration for hypoxemia and the minimum saturation of pulse oximetry were recorded.The success rate of gastroscopy,and the support situation for respiratory(including jaw-lift,mask-assisted ventilation and ventilation after tracheal intubation)were recorded.The occurrence of cough and movement during gastroscopy,the time of examination were recorded.The satisfaction of patients,operators and anesthesiologists was recorded.Results There was no patient in group T developed hypoxemia.The incidence of hypoxemia in group D was 22%,the time of duration for hypoxemia was(45.6±14.1)s.Compared with group D,the minimum saturation of pulse oximetry was significantly increased(P<0.05),the number of patients requiring jaw-lift and mask-assisted ventilation was significantly decreased(P<0.05),the success rate of gastroscopy was significantly increased(P<0.05),the incidence of cough and movement were significantly decreased(P<0.05),the time of examination was significantly shortened(P<0.05),the subjective satisfaction of patients,operators and anesthesiologists was significantly increased(P<0.05).Conclusion THRIVE can effectively prevent the occurrence of hypoxemia during painless gastroscopy in obese patients and improve the tripartite satisfaction of patients,operators and anesthesiologists.