鼻罩通气在无痛胃镜检查麻醉期间预防呼吸抑制和低氧的效果

Effect of nasal mask ventilation on preventing respiratory depression and hypoxia during anesthesia under painless gastroscopy

摘要:

目的 探讨鼻罩通气在无痛胃镜检查麻醉期间预防呼吸抑制和低氧的效果。方法 选取2022年9月－2023年3月于该院择期行无痛胃镜检查的患者246例，按随机数表法分为鼻导管吸氧组（C组）和鼻罩吸氧组（M组）。C组采用传统鼻导管给氧，M组采用麻醉鼻罩给氧。两组患者予以5 L/min预吸氧3 min，麻醉诱导后，待改良警觉/镇静（MOAA/S）评分 ≤ 1分时进胃镜。麻醉期间，C组根据经皮动脉血氧饱和度（SpO₂）实施气道干预措施，M组根据呼气末二氧化碳分压（PetCO₂）和SpO₂进行气道干预。记录麻醉过程中亚临床呼吸抑制、低氧和严重低氧的发生率。记录麻醉期间最低SpO₂值，以及抬下颌、面罩加压给氧和气管插管等干预措施实施情况。记录胃镜检查期间的退镜情况。记录入室时（T₀）、麻醉诱导后即刻（T₁）、胃镜操作结束时（T₂）和苏醒5 min时（T₃）的平均动脉压（MAP）、心率（HR）和呼吸频率（RR）。记录围手术期不良事件发生情况、麻醉医师满意度和消化内镜医师满意度。结果 与C组比较，M组亚临床呼吸抑制、低氧和严重低氧的发生率明显降低，差异均有统计学意义（P < 0.05）。M组麻醉期间SpO₂最低值高于C组，差异有统计学意义（P < 0.05）。与C组比较，M组抬下颌和面罩加压给氧实施率明显降低，差异均有统计学意义（P < 0.05）。M组因气道干预退镜率低于C组，差异有统计学意义（P < 0.05）。与T₀时点相比，两组患者T₁和T₂时点MAP、HR和RR明显下降，差异均有统计学意义（P < 0.05）。两组患者不良事件发生率比较，差异无统计学意义（P > 0.05）。M组消化内镜医师满意度高于C组，差异有统计学意义（P < 0.05）。结论 与鼻导管吸氧比较，麻醉鼻罩可及时发现胃镜检查时低通气和呼吸抑制情况，降低低氧发生率，提高气道安全性。

Abstract:

Objective To investigate the effect of nasal mask on preventing respiratory depression and hypoxia during anesthesia under painless gastroscopy.Methods 246 patients underwent elective painless gastroscopy from September 2022 to March 2023 were selected and divided into nasal catheter oxygen group (group C) and nasal mask oxygen group (group M) according to random number table method. The group C was inhaled oxygen by conventional nasal cannula, and in group M, oxygen was inhaled by a nasal mask. Patients in both groups were given 5 L/min preoxygenation for 3 min. After induction of anesthesia, gastroscopy was performed when modified observer’s assessment of alertness/sedation (MOAA/S) score ≤ 1. During anesthesia, hypoxia interventions were performed in group C based on percutaneous arterial oxygen saturation (SpO₂) and in group M based on partial pressure of end-tidal carbon dioxide (PetCO₂) and SpO₂. The incidence of subclinical respiratory depression, hypoxia and severe hypoxia during anesthesia was recorded. The minimum SpO₂ value during anesthesia was recorded; Implementation of intervention measures of jaw lifting, mask pressure oxygen and tracheal intubation. Record the number of gastroscope withdrawal cases. Mean arterial pressure (MAP), heart rate (HR), and respiratory rate (RR) were recorded at the time of entry (T₀), immediately after induction of anesthesia (T₁), at the end of gastroscopy (T₂), and 5 minutes after awakening (T₃). The occurrence of perioperative adverse events and the satisfaction of anesthesiologists and endoscopists were recorded.Results Compared with group C, the incidence of subclinical respiratory depression, hypoxia and severe hypoxia in group M was significantly decreased (P < 0.05). The minimum value of SpO₂ during anesthesia in group M was higher than that in group C (P < 0.05). The incidence of jaw-lifting and mask ventilation were lower in group M than that in group C (P < 0.05). The incidence of gastroscope withdrawal due to airway intervention in group M was lower than that in group C (P < 0.05). Compared with T₀, MAP, HR and RR of the two groups were significant reduction at T₁ and T₂ (P < 0.05). There was no significant difference in the incidence of adverse events between the two groups (P > 0.05). The satisfaction of endoscopists in group M was higher than that in group C (P < 0.05).Conclusion Compared with nasal catheter oxygen inhalation, anesthesia nasal mask can timely detect hypopnea and respiratory depression during gastroscopy, reduce the occurrence of hypoxia, and improve the airway safety of painless gastroscopy patients.