东南大学附属中大医院江北院区 消化内科，江苏 南京 210044
Department of Gastroenterology, Zhongda Hospital (Jiangbei), Southeast University, Nanjing, Jiangsu 210044, China
目的 研究老年患者无痛消化内镜检查中不良事件发生率及相关影响因素。方法 收集2019年6月－2021年6月284例接受无痛消化内镜检查的老年患者的临床资料，记录不良事件发生率。采用Cox风险回归模型，分析发生不良事件的相关影响因素，并建立指数方程作为预测模型，分析预测模型判断不良事件的价值。结果 284例老年患者中，74例发生不良事件，发生率为26.06%。发生不良事件的患者作为观察组（74例）。其中，心率波动32例，血压波动28例，心律失常9例，出血4例，肠穿孔1例。未发生不良事件的患者作为对照组（210例）。观察组与对照组年龄、体重指数（BMI）、慢性阻塞性肺疾病（COPD）、糖尿病、鼾病史、病变类型及颌面部异常情况比较，差异均有统计学意义（P < 0.05）。Cox风险回归模型分析显示，年龄（HR＾ = 1.763，95%CI：1.108～2.805，β = 0.567，P = 0.017）、BMI（HR＾ = 2.608，95%CI：1.916～3.550，β = 0.959，P = 0.000）、COPD（HR＾ = 1.702，95%CI：1.125～2.575，β = 0.532，P = 0.012）及鼾病史（HR＾ = 2.258，95%CI：1.403～3.634，β = 0.814，P = 0.001）是老年患者无痛消化内镜检查中发生不良事件的高危因素，糖尿病、病变类型及颌面部异常与老年患者无痛消化内镜检查中不良事件的发生无关（P > 0.05）。根据Cox风险回归模型分析结果，建立指数方程Y = 0.567X1 + 0.959X2 + 0.532X4 + 0.814X5（X1 = 年龄，X2 = BMI，X4 = COPD，X5 = 鼾病史）。受试者操作特征曲线（ROC）分析显示，采用指数方程判断不良事件，具有较高的准确性（AUC = 0.781，SE = 0.029，95%CI：0.724～0.837），敏感度为0.824，特异度为0.514。结论 老年患者无痛消化内镜检查中，心肺不良事件发生率较高，其发生与患者年龄、BMI、COPD及鼾病史有关，据此建立指数方程来判断不良事件，具有较高的敏感性。
Objective To study the incidence of adverse events in painless digestive endoscopy in the elderly and analysis of related factors.Methods The clinical data of 284 patients who underwent painless digestive endoscopy from June 2019 to June 2021 were collected, the incidence of adverse events was recorded. The Cox risk regression model was used to analyze the risk related factors of adverse events, and the index equation was established as the prediction model, the value of prediction model in judging adverse events was analyzed.Results Among the 284 patients, 74 had adverse events, the incidence was 26.06%, which were as the observation group, there were 32 cases of heart rate fluctuation, 28 cases of blood pressure fluctuation, 9 cases of arrhythmia, 4 cases of bleeding and 1 case of intestinal perforation, 210 cases were as the control group. The age, body mass index, chronic obstructive pulmonary diseases (COPD), diabetes and snoring history, lesion characteristics and frontal and facial abnormalities were significantly different between the two groups (P < 0.05). Cox risk regression model analysis showed that age (HR＾ = 1.763, 95% CI: 1.108～2.805, β = 0.567, P = 0.017）, BMI (HR＾ = 2.608, 95%CI: 1.916～3.550, β = 0.959, P = 0.000), COPD (HR＾ = 1.702, 95%CI: 1.125～2.575, β = 0.532, P = 0.012) and snoring history (HR＾ = 2.258, 95%CI: 1.403～3.634, β = 0.814, P = 0.001) were high risk factor for adverse events in painless digestive endoscopy in the elderly, the diabetes, lesion and frontal and facial abnormalities were not associated with adverse events in painless digestive endoscopy in elderly patients (P > 0.05). The exponential equation was established according to the analysis results of Cox risk regression model: Y = 0.567X1 + 0.959X2 + 0.532X4 + 0.814X5 (X1 = age, X2 = BMI, X4 = COPD, X5 = history of snoring). The receiver operating characteristic (ROC) curve analysis showed that the exponential equation had high accuracy in judging adverse events (AUC = 0.781, SE = 0.029, 95%CI: 0.724~0.837), the sensitivity was 0.824 and the specificity was 0.514.Conclusion The incidence of pulmonary adverse events in elderly patients undergoing painless digestive endoscopy is high,its occurrence is related to the patient's age, body mass index, COPD and snoring history. Therefore, the establishment of index equation has high sensitivity to judge adverse events.