内镜喉罩在肥胖患者行上消化道内镜下黏膜切除术中的应用

Application of endoscopic laryngeal mask in obese patients undergoing upper gastrointestinal endoscopic mucosal resection

目的分析内镜喉罩在肥胖患者行上消化道内镜下黏膜切除术(EMR)中的应用效果。方法采用前瞻性研究的方法,选择南京医科大学附属南京医院2020年7月至2022年5月行上消化道EMR的肥胖患者90例。将患者按照随机数字表法分为内镜喉罩组(采用全身麻醉内镜喉罩通气)和鼻导管组(采用常规非插管静脉麻醉),每组45例。记录EMR时间,围手术期最低脉搏血氧饱和度(SpO_(2)),围手术期SpO_(2)、平均动脉压(MAP)和心率变化,苏醒时间,术后麻醉后护理病房(PACU)停留时间,不良反应,医患满意度。结果两组EMR时间和术后PACU停留时间比较差异无统计学意义(P>0.05)。两组术前和麻醉诱导期最低SpO_(2)比较差异无统计学意义(P>0.05);内镜喉罩组EMR期最低SpO 2明显高于鼻导管组(0.990±0.010比0.951±0.037),差异有统计学意义(P<0.01)。两组各时间点心率和MAP比较差异无统计学意义(P>0.05);两组入手术室时和离开PACU时SpO_(2)比较差异无统计学意义(P>0.05),内镜喉罩组内镜置入即刻和手术结束时SpO_(2)明显高于鼻导管组(0.989±0.009比0.976±0.011和0.987±0.010比0.981±0.009),差异有统计学意义(P<0.01)。内镜喉罩组苏醒时间明显长于鼻导管组[(6.7±1.1)min比(4.6±1.2)min],差异有统计学意义(P<0.01)。两组均未发生误吸、声嘶和气道痉挛。两组咽痛、心动过缓、低血压、腹痛腹胀和术后恶心呕吐发生率比较差异无统计学意义(P>0.05)。内镜喉罩组呛咳体动发生率明显低于鼻导管组[2.2%(1/45)比24.4%(11/45)],差异有统计学意义(P<0.01)。两组患者满意度比较差异无统计学意义(P>0.05);内镜喉罩组麻醉医师和消化内镜医师满意度明显高于鼻导管组[95.6%(43/45)比66.7%(30/45)和88.9%(40/45)比71.1%(32/45)],差异有统计学意义(P<0.01或<0.05)。结论肥胖患者行上消化道EMR时应用内镜喉罩可以有效改善通气不足导致的低氧情况,同时并不会引起血流动力学的剧烈波动,也不增加患者咽喉部不适感的发生率,但稍延长了苏醒时间。

Objective To analyze the efficacy of endoscopic laryngeal mask in obese patients undergoing upper gastrointestinal endoscopic mucosal resection(EMR).Methods Adopting a prospective research approach,90 obese patients who underwent upper gastrointestinal EMR from July 2020 to May 2022 in Nanjing First Hospital,Nanjing Medical University were selected.The patients were divided into endoscopic laryngeal mask group(using general anesthesia with endoscopic laryngeal mask ventilation)and nasal catheter group(using conventional non intubated intravenous anesthesia)by random digits table method with 45 cases in each.The EMR time;minimum pulse oxygen saturation(SpO_(2))during perioperative period;changes of SpO_(2),mean arterial pressure(MAP)and heart rate during perioperative period;palinesthesia time;postoperative postanesthesia care unit(PACU)residence time;adverse reactions;satisfaction levels of doctor and patient satisfaction were recorded.ResultsThere were no statistical difference in EMR time and postoperative PACU residence time between two groups(P>0.05).There were no statistical difference in minimum SpO_(2) preoperative and anesthesia induction period between two groups(P>0.05);the minimum SpO_(2) EMR period in endoscopic laryngeal mask group was significantly higher than those in nasal catheter group(0.990±0.010 vs.0.951±0.037),and there was statistical difference(P<0.01).There were no statistical difference in heart rate and MAP during perioperative period between two groups(P>0.05).There were no statistical difference in SpO_(2) entering the operating room and leaving the PACU between two groups(P>0.05),SpO_(2) immediately after endoscopic insertion and at the end of surgery in endoscopic laryngeal mask group was significantly higher than that in nasal catheter group(0.989±0.009 vs.0.976±0.011 and 0.987±0.010 vs.0.981±0.009),and there was statistical difference(P<0.01).The palinesthesia time in endoscopic laryngeal mask group was significantly longer than that in nasal catheter group:(6.7±1.1)min vs.(4.6±1.2)min,and there was statistical difference(P<0.01).Both groups did not experience aspiration,hoarseness or airway spasm.There were no statistical difference in the incidences of pharyngalgia,bradycardia,hypotension,abdominal pain and bloating,postoperative nausea and vomiting between two groups(P>0.05).The incidence of bucking and body movement in endoscopic laryngeal mask group was significantly lower than that in nasal catheter group:2.2%(1/45)vs.24.4%(11/45),and there was statistical difference(P<0.01).There were no statistical difference in the satisfaction level of patient between two groups(P>0.05);the satisfaction levels of anesthesiologists and endoscopists in endoscopic laryngeal mask group were significantly higher than those in nasal catheter group:95.6%(43/45)vs.66.7%(30/45)and 88.9%(40/45)vs.71.1%(32/45),and there were statistical differences(P<0.01 or<0.05).ConclusionsThe application of endoscopic laryngeal mask in upper gastrointestinal EMR in obese patients can effectively improve the hypoxia caused by insufficient ventilation.At the same time,it will not cause drastic fluctuations in hemodynamics,and it does not increase the incidence of throat discomfort,but it slightly extends the awakening time.