末梢灌注指数预测无痛胃镜最佳进镜时间点的应用研究

Research on predicting the optimal insertion time point of painless gastroscopy by tip perfusion index

摘要:

目的 比较末梢灌注指数（TPI）与睫毛反射消失指导无痛胃镜进镜时间，以寻找胃镜检查的最佳进镜时机。方法 选择2024年1月－2024年6月该院择期行无痛胃镜检查的患者362例，按照随机数表法分为N组（122例，睫毛反射消失后直接进镜检查）、NS组（121例，睫毛反射消失30 s后进镜检查）和E组［119例，TPI连续增大（新测量的数值 > 前一测量数值3次以上）后进镜］。比较3组患者麻醉诱导前（T₀）、进胃镜前（T₁）、胃镜过咽喉时（T₂）和镜检完成后（T₃）的心率（HR）、平均动脉压（MAP）和经皮动脉血氧饱和度（SpO₂）的变化。比较3组患者进镜等待时间（全身麻醉诱导完成后到进镜时刻）和不良反应发生率。结果 N组进镜等待时间为（5.52±2.17）s，明显短于E组的（18.60±3.89）s和NS组的（35.74±2.17）s，差异均有统计学意义（P < 0.01）。E组T₁时点SpO₂明显高于N组和NS组，差异均有统计学意义（P < 0.01），3组患者T₀、T₂和T₃时点的SpO₂比较，差异均无统计学意义（P > 0.05）；3组患者T₀、T₁、T₂和T₃时点HR和MAP比较，差异均无统计学意义（P > 0.05）；3组患者T₀时点的MAP和HR明显高于T₁、T₂和T₃时点，差异均有统计学意义（P < 0.05）。E组托下颌发生率明显低于NS组和N组，体动发生率和丙泊酚追加率明显低于N组，呛咳发生率明显低于NS组，差异均有统计学意义（P < 0.05）。结论 TPI预测无痛胃镜的进镜时机，具有简便、无创、客观和实时等优势，明显优于通过睫毛反射来指导进镜时机。当TPI从低点出现连续增大时，是无痛胃镜进镜的最佳时机。

Abstract:

Objective Compare the tip perfusion index (TPI) with the disappearance of eyelash reflex in guiding the timing of intubation for painless gastroscopy, in order to find the optimal timing for painless gastroscopy.Methods 362 patients who underwent painless gastroscopy from January to June 2024 were selected. According to the random number table method, they were divided into group N (122 cases, direct endoscopic examination after the disappearance of eyelash reflex), group NS (121 cases, endoscopic examination 30 seconds after the disappearance of eyelash reflex), and group E [119 cases, endoscopic examination after continuous increase of TPI (newly measured value > previous measured value more than 3 times)]. The changes in heart rate (HR), mean arterial pressure (MAP), and percutaneous arterial oxygen saturation (SpO₂) before anesthesia induction (T₀), before intubation (T₁), through the throat (T₂), and after examination (T₃) were recorded and compared among the three groups. The intubation waiting time (from the completion of general anesthesia induction to the moment of intubation) and the incidence of adverse reaction were compared among the three groups.Results The waiting time for endoscopy in group N was (5.52 ± 2.17) s, which was significantly shorter than that in group E [(18.60 ± 3.89) s] and group NS [(35.74 ± 2.17) s], and the differences were statistically significant (P < 0.01). At T₁ time point, the SpO₂ of the group E was significantly higher than that of group N and group NS, the differences were statistically significant (P < 0.01). There were no statistical difference of SpO₂ at T₀, T₂ and T₃ time points among the three groups (P > 0.05). There were no statistical differences in HR and MAP at the T₀, T₁, T₂ and T₃ time points among the three groups (P > 0.05); The MAP and HR of the three groups of patients at time point T₀ were significantly higher than those at time points T₁, T₂ and T₃, and the differences were statistically significant (P < 0.05). The incidence of lower jaw support in group E was significantly lower than that in group NS and group N, the incidence of body movement and the rate of additional propofol administration were significantly lower than those in group N, the incidence of coughing was significantly lower than that in group NS, and the differences were statistically significant (P < 0.05).Conclusion The TPI is a simple, non-invasive, objective, and real-time predictor of the timing of intubation for painless gastroscopy, which is significantly better than guiding the timing of intubation through the eyelash reflex. When the TPI continuously increases from a low point, it is a good time for painless gastroscopy intubation.