鼻导管联合面罩吸氧与快充式经鼻湿化高流量通气在老年患者无痛肠镜检查中的应用效果

Clinical effect of nasal cannula combined with mask oxygen inhalation and transnasal humidified rapid-insufflation ventilatory exchange on painless colonoscopy in elderly patients

摘要:

目的 探讨鼻导管联合面罩吸氧与快充式经鼻湿化高流量通气（THRIVE）在老年患者无痛肠镜检查中的应用效果。方法 纳入150例行无痛肠镜检查的老年患者，美国麻醉医师协会（ASA）分级为Ⅰ级或Ⅱ级，年龄65～80岁，随机将患者分为鼻导管组（C组）、鼻导管联合面罩组（M组）和THRIVE组（T组），每组50例。3组患者分别给予鼻导管吸氧、鼻导管吸氧联合面罩吸氧及THRIVE设备吸氧。比较3组患者呼吸相关不良事件及干预措施、不良反应发生率、无痛肠镜检查情况、患者、麻醉医生及内镜医生满意度。结果 M组和T组亚临床呼吸抑制及缺氧发生率较C组低，托下颌、增加氧流量及面罩通气等气道干预措施使用率较C组低，患者体动发生率较C组低，麻醉医生及内镜医生满意度较C组高，差异均有统计学意义（P < 0.05）。M组与T组呼吸相关不良事件、气道干预措施及满意度比较，差异均无统计学意义（P > 0.05）。结论 鼻导管联合面罩吸氧及THRIVE可减少老年患者无痛肠镜操作过程中呼吸相关不良事件及干预措施，减少患者体动，提高麻醉医生及内镜医生满意度。鼻导管联合面罩吸氧操作便捷，可在临床中应用推广。

Abstract:

Objective To investigate the clinical effect of nasal cannula combined with mask oxygen inhalation and transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) on painless colonoscopy in elderly patients.Methods 150 elderly patients aged 65 ~ 80, American Society of Anesthesiologists (ASA) were I to II, scheduled for painless colonoscopy, were enrolled and randomly assigned to three groups: nasal cannula group (group C), nasal cannula combined with mask group (groups M) and THRIVE group (group T), 50 patients in each group. Patients in three groups were given pure oxygen inhalation via nasal cannula, nasal cannula combined with face mask and THRIVE. Compare respiratory-related adverse events and intervention, incidence of adverse reactions, painless colonoscopy procedure and satisfaction of patients, anesthesiologists and endoscopist.Results The incidence of subclinical respiratory depression and hypoxia in group M and group T were lower than those in group C, the airway interventions such as jaw lift, increasing oxygen flow and mask ventilation in group M and group T were less than those in group C, the incidence of body movement in group M and group T was lower than that in group C, and the satisfaction of anesthesiologists and endoscopist in group M and group T were higher than those in group C (P < 0.05). There were no significant differences in respiratory-related adverse events, airway intervention measures and satisfaction score between group M and group T (P > 0.05).Conclusion Nasal cannula combined with mask oxygen inhalation as well as THRIVE could reduce respiratory related adverse events and airway intervention measures during painless colonoscopy in the elderly patients, reduce the occurrence of patients’ body movement, improve the satisfaction of anesthesiologists and endoscopist. The operation of nasal cannula combined with mask oxygen inhalation is convenient and can be used in clinic practice.