结直肠息肉无痛内镜下黏膜切除术中快充式经鼻湿化高流量通气的效果分析

Effect Analysis of Transnasal Humidified Rapid-Insufflation Ventilatory Exchange in Painless Endoscopic Mucosal Resection of Colorectal Polyps

目的:分析结直肠息肉无痛内镜下黏膜切除术中快充式经鼻湿化高流量通气(THRIVE)的安全性、可行性。方法:选取2021年11月至2023年11月拟于我院接受无痛内镜下黏膜切除术治疗的80例结直肠息肉患者,电脑随机数表法分为对照组和观察组,各40例,对照组患者术中常规经鼻吸氧,观察组患者术中THRIVE。比较2组围术期血流动力学指标心率(HR)、血氧饱和度(SpO_(2))、pH值、二氧化碳分压(PaCO_(2))及动脉氧分压(PaO_(2)),麻醉期间缺氧事件发生情况及处理方法,其他不良事件发生情况,以及手术时间、术中丙泊酚用量及术后苏醒时间等。结果:1)血流动力学指标:与术前静息5 min(T0)时相比,2组进镜后1 min(T1)、进镜回盲瓣处(T2)时HR均明显减慢,术毕(T3)时恢复至术前水平,2组同时间点HR比较差异均无统计学意义(P>0.05)。观察组T0、T1、T2、T3时SpO_(2)波动不明显(P>0.05);对照组T1时SpO_(2)较T0时明显降低(P<0.05),且明显低于观察组同时刻(P<0.05)。观察组T0、T2、T3时PaCO_(2)波动不明显(P>0.05);对照组T2、T3时PaCO_(2)较T0时明显升高(P<0.05),且明显低于观察组同时刻(P<0.05)。2组T2、T3时PaO_(2)均较T0时显著升高(P<0.05),但组间无明显差异(P>0.05)。2组T0、T2、T3时pH值均无明显波动(P>0.05)。2)缺氧事件发生情况及处理方法:观察组亚临床呼吸抑制(7.50%)及低氧(0)发生率均低于对照组(20.00%,12.50%),P<0.05。除对照组1例严重低氧患者面罩通气外,2组发生缺氧事件者均经托下颚开放气道缓解。3)其他不良事件发生情况:2组胃进气、心动过缓、低血压、高血压、反流误吸、苏醒躁动、术后恶心呕吐等发生率比较差异均无统计学意义,P>0.05。4)手术指标:2组手术时间、术中丙泊酚用量及术后苏醒时间比较,差异均无统计学意义,P>0.05。结论:结直肠息肉无痛内镜下黏膜切除术中THRIVE,有助于稳定患者血流动力学指标,降低缺氧事件发生率而不增加其他不良事件,提高手术安全性。

Objective To analyze the safety and feasibility of transnasal humidified rapid-insufflation ventilatory exchange(THRIVE)during painless endoscopic mucosal resection of colorectal polyps.Methods A total of 80 patients with colorectal polyps who were scheduled to receive painless endoscopic mucosal resection in our hospital from November 2021 to November 2023 were selected and divided into control group and observation group by computer random number table method,with 40 cases in each group.Patients in the control group received conventional nasal oxygen inhalation during the operation,while patients in the observation group received THRIVE during the operation.Perioperative hemodynamic indexes of heart rate(HR),blood oxygen saturation(SpO_(2)),pH value,partial pressure of carbon dioxide(PaCO_(2))and arterial oxygen partial pressure(PaO_(2)),occurrence and treatment of anoxia events during anesthesia,occurrence of other adverse events,as well as operation time,intraoperative propofol dosage and postoperative recovery time were compared between the two groups.Results 1)Hemodynamic indexes:Compared with the preoperative resting time of 5 min(T0),HR in both groups decreased significantly 1 min after entry of endoscope(T1)and entry to ileocecal valve(T2),and recovered to the preoperative level at the end of operation(T3).There was no statistical significance in HR between the two groups at the same time point(P>0.05).SpO_(2) did not fluctuate significantly at T0,T1,T2 and T3 in the observation group(P>0.05).SpO_(2) in the control group at T1 was significantly lower than that at T0(P<0.05),and was significantly lower than that in the observation group at the same time(P<0.05).PaCO_(2) did not fluctuate significantly at T0,T2 and T3 in the observation group(P>0.05).PaCO_(2) at T2 and T3 in the control group was significantly higher than that at T0(P<0.05),and significantly lower than that at the same time in the observation group(P<0.05).PaO_(2) at T2 and T3 in both groups was significantly higher than that at T0(P<0.05),but there was no significant difference between groups(P>0.05).There was no significant change in pH value at T0,T2 and T3 in both groups(P>0.05).2)Occurrence and treatment of hypoxia events:The incidence of subclinical respiratory depression(7.50%)and hypoxia(0)in the observation group was lower than that in the control group(20.00%,12.50%)(P<0.05).Except for 1 case of severe hypoxia in the control group,all patients with hypoxia events in both groups were relieved by opening the airway and supporting the lower jaw.3)Occurrence of other adverse events:There were no statistically significant differences in the incidence of gastric intake of air,bradycardia,hypotension,hypertension,reflux,aspiration,agitation,postoperative nausea and vomiting between the two groups(P>0.05).4)Surgical indexes:There were no significant differences in operation time,intraoperative propofol dosage and postoperative recovery time between the two groups(P>0.05).Conclusion In the painless endoscopic mucosal resection of colorectal polyps,THRIVE is helpful to stabilize the hemodynamic indexes of patients,reduce the incidence of hypoxia events without increasing other adverse events,and improve the surgical safety.