老年体检人群消化内镜检查突发不良事件的影响因素分析及风险管理

Analysis of influencing factors and risk management of sudden adverse events during digestive endoscopy in elderly physical examination population

目的分析老年体检人群内镜检查突发不良事件的相关影响因素并探索风险预警管理策略。方法选择2023年1月—2023年12月在海军军医大学第二附属医院体检并行消化内镜检查的受检者102例,通过问卷调查收集、分析检查突发不良事件,并以单因素分析再进行多因素Logistic回归分析危险因素,并探讨风险管理策略。结果本次共发放问卷102份,最终收集有效问卷98份,回收率为96.08%。98份问卷中:8例(8.16%)发生低血压,3例(3.06%)发生心律失常,4例(4.14%)发生低氧血症,5例(5.10%)发生误吸,8例(8.16%)发生呛咳,3例(3.06%)发生喉痉挛,共有31例患者发生不良事件,发生率为31.84%(31/98)。依据是否出现不良事件分为不良事件组(n=31)、无不良事件组(n=67)。单因素分析发现2组在年龄、麻醉医师给药剂量大、内镜医师操作不熟练、超重、合并基础疾病、吸烟史、饮酒、慢性肺部疾病史存在统计学差异(P<0.05);在性别、文化程度上无明显差异(P>0.05)。经多因素Logistic回归分析发现,年龄、麻醉医师给药剂量大、内镜医师操作不熟练、肥胖、合并基础疾病、肺部疾病史均为消化内镜检查突发不良事件的独立危险因素(P<0.05)。结论老年、麻醉医师给药剂量大、内镜医师操作不熟练、肥胖、合并基础疾病、肺部疾病史均与消化内镜诊疗不良事件的发生有关,需制定风险预警管理策略以降低不良事件发生率,提高诊疗安全性。

Objective To analyze the related influencing factors of sudden adverse events during endoscopy in elderly physical examination population and explore theirrisk early warning management strategy.Methods A total of 102 elderly patients who underwent physical examination and digestive endoscopy in Second Affiliated Hospital of Naval Medical University from January 2023 to December 2023 were selected.The sudden adverse events during the examination were collected and analyzed through a questionnaire survey.The univariate analysis and multivariate logistic regression analysis were performed to analyze the risk factors.Then risk management strategy was explored.Results A total of 102 questionnaires were sent out,and 98 valid questionnaires were collected,with a recovery rate of 96.08%.Among the 98 questionnaires,8 cases(8.16%)experienced hypotension,3 ones(3.06%)did arrhythmia,4 ones(4.14%)did hypoxemia,5 ones(5.10%)did aspiration,8 ones(8.16%)did coughing,and 3 ones(3.06%)did laryngeal spasms.A total of 31 subjects experienced adverse events,with an incidence of 31.84%(31/98).They were divided into adverse event group(n=31)and non-adverse event group(n=67)according to whether adverse events occurred.Univariate analysis showed that there were statistical differences between the two groups in age,large dosage of anesthesia by anesthesiologists,unskilled operation ofendoscopists,overweight,combined underlying diseases,smoking history,drinking and history of chronic lung disease(P<0.05).There were no significant differences in gender and education level(P>0.05).Multivariate logistic regression analysis showed that age,large dosage of anesthesia by anesthesiologists,unskilled operation of endoscopists,obesity,combined underlying diseases and history of lung disease were independent risk factors for sudden adverse events duringdigestive endoscopy(P<0.05).Conclusion The old age,large dosage of anesthesia by anesthesiologists,unskilled operation of endoscopists,obesity,combined underlying diseases and history of pulmonary diseases are all related to the occurrence of adverse events duringthe diagnosis and treatment of digestive endoscopy.Risk earlywarning and management strategy should be developed to reduce the incidence of adverse events and improve the safety of diagnosis and treatment.