新型冠状病毒感染患者无痛消化内镜诊疗术中低氧血症的影响因素

Influencing factors for hypoxemia during painless gastrointestinal endoscopy in patients with COVID-19

目的筛选新型冠状病毒感染患者无痛消化内镜诊疗(PGIE)术中低氧血症的危险因素。方法回顾性收集2022年12月至2023年4月于我院行PGIE的新型冠状病毒感染患者病例资料,根据术中低氧血症发生情况分为低氧血症组(n=201)和非低氧血症组(n=747),采用logistic回归分析法,筛选术中低氧血症的影响因素。结果2组年龄比率、ASA分级比例、吸烟程度比率、高血压病程比率、PGIE类型比率、实施PGIE时段、诱导前MAP、距离确诊新型冠状病毒感染时间、新型冠状病毒感染分型比率和咳嗽情况比率比较差异有统计学意义(P<0.05)。多因素logistic回归分析结果显示:年龄51~65岁、年龄>65岁、吸烟程度-轻度、吸烟程度-中重度、新型冠状病毒感染期间相关症状及体征-至PGIE咳嗽未愈、新型冠状病毒感染期间相关症状及体征-至PGIE咳嗽已愈是术中发生低氧血症的独立危险因素;PGIE类型-结肠镜、距离确诊新型冠状病毒感染时间43~56 d、距离确诊新型冠状病毒感染时间57~70 d、距离确诊新型冠状病毒感染时间>70 d是术中低氧血症的独立保护因素。结论年龄>50岁、有吸烟习惯、新型冠状病毒感染期间出现咳嗽是PGIE术中低氧血症的独立危险因素;PGIE类型为结肠镜和距离确诊新型冠状病毒感染时间>42 d是术中低氧血症的独立保护因素。

Objective:To identify the risk factors for hypoxemia during painless gastrointestinal endoscopy(PGIE)in patients with COVID-19.Methods:Clinical data of COVID-19 patients who underwent PGIE in our hospital from December 2022 through April 2023 were retrospectively collected.The patients were divided into hypoxemia group(n=201)and non-hypoxemia group(n=747)based on the occurrence of intraoperative hypoxemia.The logistic regression analysis was used to identify the influencing factors for intraoperative hypoxemia.Results:There were significant differences in age ratio,American Society of Anesthesiologists Physical Status classification ratio,ratio of smoking degree,ratio of hypertension course,ratio of PGIE type,period of implementing PGIE,MAP before induction,time to diagnosis of COVID-19,COVID-19 classification ratio and cough ratio between the two groups(P<0.05).Multivariate logistic regression analysis showed that age 51-65 yr,age>65 yr,smoking degree-mild,smoking degree-moderate to severe,COVID-19 related signs and symptoms-cough not healed until PGIE,COVID-19-related signs and symptoms-cough healed until PGIE were independent risk factors for intraoperative hypoxemia;the PGIE type-colonoscopy,time to diagnosis of COVID-19 and PGIE 43-56 days,time to diagnosis of COVID-19 and PGIE 57-70 days,and time to diagnosis of COVID-19 and PGIE>70 days were independent protective factors for intraoperative hypoxemia.Conclusions:Age>50 yr,having smoking habit and cough shown during COVID-19 are independent risk factors for intraoperative hypoxemia;PGIE type-colonoscopy and time to diagnosis of COVID-19 and PGIE>42 days are independent protective factors for intraoperative hypoxemia.