对比观察鼻罩导气管在胃镜检查麻醉期间预防低氧血症的作用

Effect of nasal mask airway on the prevention of hypoxemia during gastroscopic anesthesia

目的与常规鼻导管对比,观察胃镜检查麻醉过程中鼻罩导气管可否预防或减少低氧血症的发生。方法选取拟行胃镜检查麻醉的患者180例,按随机数字表法分为两组:鼻导管组(NC组,86例)和鼻罩导气管组(NMA组,94例)。麻醉前两组患者分别配戴鼻导管或鼻罩导气管后均吸纯氧3 min,给予舒芬太尼0.05μg/kg和异丙酚2 mg/kg,待警觉/镇静(Observer's Assessment of Alertness/Sedation,OAA/S)评分达到1分时进行胃镜检查操作。记录两组患者一般资料、胃镜检查操作时长、异丙酚用量,记录两组患者轻中度低氧血症(75%<SpO_(2)<90%)、严重低氧血症(SpO_(2)≤75%)的发生率及低氧血症总发生率,最低SpO_(2),需要进行干预(托下颌、面罩通气、气管插管)的比例及不良事件(鼻干、喉痉挛、心动过速、心动过缓、高血压、低血压、苏醒延迟、恶心、躁动)发生情况。结果两组患者一般资料、胃镜检查操作时长、异丙酚用量差异无统计学意义(P>0.05)。NMA组轻中度低氧血症发生率、严重低氧血症发生率、低氧血症总发生率、托下颌比例、需要进行干预总比例低于NC组(P<0.05),最低SpO_(2)高于NC组(P<0.05)。两组患者鼻干、喉痉挛、心动过速、心动过缓、高血压、低血压、苏醒延迟、恶心、躁动发生率差异无统计学意义(P>0.05)。结论在胃镜检查麻醉过程中,与常规鼻导管相比,鼻罩导气管能够预防严重低氧血症的发生,显著降低轻中度低氧血症发生率,减少对气道操作的需求,提高了胃镜检查麻醉的安全性。

Objective To observe whether nasal mask airway can prevent or reduce the occurrence of hypoxemia during gastroscopic anesthesia by comparing with nasal catheter.Methods A total of 180 patients who were scheduled for gastroscopic anesthesia were enrolled.According to the random number table method,they were divided into two groups:a nasal cannula group(NC group,n=86)and a nasal mask airway group(NMA group,n=94).Before anesthesia,patients in both groups were inserted with nasal catheter or nasal mask airway and inhaled pure oxygen for 3 min.After administration with sufentanil(0.05μg/kg)and propofol(2 mg/kg)for anesthesia induction,gastroscopic examination was performed when the Observer's Assessment of Alertness/Sedation(OAA/S)was 1 point.Their general information,gastroscopic duration and propofol dosage were recorded.The total incidence of hypoxemia,including mild to moderate hypoxemia(75%<SpO_(2)<90%)and severe hypoxemia(SpO_(2)≤75%),the lowest SpO_(2),airway manipulation(jaw‑lifting,mask ventilation,endotracheal intubation),and adverse reactions(nasal stem,laryngospasm,tachycardia,bradycardia,hypertension,hypotension,delayed recovery,nausea and dysphoria)were also recorded.Results There was no statistical difference in general information,gastroscopic duration and propofol dosage between the two groups.The NMA group showed decreases in the incidences of mild to moderate hypoxemia,severe hypoxemia,total hypoxemia,jaw‑lifting,and total airway manipulation than the NC group(P<0.05),the lowest SpO_(2)in the NMA group was higher than the NC group(P<0.05).There were no statistcial difference between two groups in the incidence of nasal stem,laryngospasm,tachycardia,bradycardia,hypertension,hypotension,delayed recovery,nausea and dysphoria(P<0.05).Conclusions Compared with nasal cannula,nasal mask airway can prevent the occurrence of severe hypoxemia,remarkably reduce the incidence of mild to moderate hypoxemia,and reduce the requirement of airway manipulation,which can improve the safety of gastroscopic anesthesia.