郑州大学第一附属医院 麻醉与围术期医学部，河南 郑州 450052
Department of Anesthesiology and Perioperative Medicine, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, China
目的 评价改良鼻咽通气道机械通气预防阻塞性睡眠呼吸暂停综合征（OSAS）患者无痛胃镜检查术中缺氧的效果。方法 将90例行无痛胃镜检查术的OSAS患者随机分为3组：鼻导管吸氧组（C组）、改良鼻咽通气道吸氧组（N组）和鼻咽通气道机械通气组（M组）。C组经鼻导管吸纯氧5 L/min；N组置入改良鼻咽通气道，并吸纯氧5 L/min；M组置入改良鼻咽通气道，并连接麻醉机行机械通气。主要观察指标为术中缺氧的发生情况；次要观察指标为：亚临床呼吸抑制和重度缺氧发生情况，缺氧事件处理措施（抬下颌、面罩加压通气和气管插管机械通气）使用情况，术中和术后体动、呛咳、鼻出血、咽痛和口腔干燥等不良反应发生情况，麻醉医师、操作医师和患者的满意度评分。结果 与C组比较，N组缺氧发生率降低（P < 0.05），M组缺氧发生率、亚临床呼吸抑制发生率、抬下颌使用率和呛咳发生率均降低，胃镜医师和麻醉医师满意度升高（均P < 0.05）。与N组比较，M组缺氧发生率降低（P < 0.05）。3组患者体动、鼻出血、咽痛和口腔干燥发生率比较，差异均无统计学意义（P > 0.05）。结论 改良鼻咽通气道机械通气可有效降低OSAS患者无痛胃镜检查术中缺氧的发生率，且不良反应轻微，耐受性好。
Objective To evaluate the efficiency of ventilation through modified nasopharyngeal airway to prevent hypoxia during painless gastroscopy in patients with obstructive sleep apnea syndrome (OSAS).Methods 90 patients underwent painless gastroscopy were randomized divided into the following 3 groups: the supplementary oxygen via nasal cannula group (group C), the supplementary oxygen via modified nasopharyngeal airway group (group N) and the ventilation via modified nasopharyngeal airway group (group M). In the group C, O2 (5 L/min) was supplied via nasal cannula; In the group N, O2 (5 L/min) was supplied via modified nasopharyngeal airway; In the group M, ventilation was performed via a modified nasopharyngeal airway by connecting an anesthetic machine. The primary outcome of interest was the incidence of hypoxia. Secondary outcomes included subclinical respiratory depression, severe hypoxia, the necessary interventions (jaw lift, mask ventilation, and intubation) used to treat the adverse events, intreoperative and postoperative adverse events such as body movement, cough, pharyngalgia, xerostomia, nasal bleeding, and the satisfaction of the physician, anesthetist, and patient.Results Compared with the group C, the incidence of hypoxia was decreased in the group N (P < 0.05), the incidence of subclinical respiratory depression, the incidence of hypoxia, the requirement of jaw lift, and the incidence of cough were decreased in the group M, the satisfaction of the anesthetist and physician were significantly higher in the group M (P < 0.05). Compared with the group N, the incidence of hypoxia was decreased in the group M (P < 0.05). There were no significant difference in the incidence of body movement, nasal bleeding, pharyngalgia, and xerostomia among the 3 groups (P > 0.05).Conclusion The modified nasopharyngeal airway ventilation can effectively reduce the incidence of hypoxia during painless gastroscopy in patients with OSAS, with minimal related adverse events and good tolerance.