PetCO2监测型鼻咽通气道在阻塞型睡眠呼吸暂停综合征患者胃镜精查麻醉中的应用研究

doi:10.3969/j.issn.1674-8115.2023.12.009

摘要/Abstract

摘要：

目的·探究PetCO₂监测型鼻咽通气道在阻塞型睡眠呼吸暂停综合征（obstructive sleep apnea syndrome，OSAS）患者无痛胃镜精查中的预防缺氧的效果。方法·选择2023年2—6月于河南省许昌市中心医院择期行胃镜精查麻醉的OSAS患者80例，随机将其分为PetCO₂监测型鼻咽通气道组（T组）和传统鼻咽通气道组（B组），每组40例。收集并比较2组患者的一般资料、围术期相关资料及麻醉用药量。观察2组患者麻醉前（T0）、麻醉后入镜时（T1）、入镜3 min（T2）、入镜10 min（T3）和退镜时（T4）的收缩压（systolic blood pressure，SBP）、舒张压（diastolic blood pressure，DBP）、心率（heart rate，HR）和脉搏血氧饱和度（pulse oxygen saturation，SpO₂），并记录体动和低氧血症发生率以及其预防缺氧的效果（面罩加压给氧率、托下颌率和挤压胸廓辅助呼吸率）。结果·患者一般资料、围术期相关资料和麻醉用药量的组间差异均无统计学意义。在T1和T2时，T组患者的SpO₂高于B组（T1：P=0.041；T2：P=0.012），SBP、DBP和HR的组间差异无统计学意义；而在其余时间点，患者的该4个指标的组间差异亦均无统计学意义。与B组比较，T组患者的体动发生率、低氧血症发生率、面罩加压给氧率、托下颌率和挤压胸廓辅助呼吸率均较低（均P=0.000）。结论·PetCO₂监测型鼻咽通气道有利于实时观察OSAS患者在胃镜精查麻醉中的肺通气状态，并能够及时指导临床进行干预，降低术中低氧血症的发生率，从而提高麻醉的安全性。

关键词: PetCO₂监测型鼻咽通气道, 胃镜精查, 阻塞型睡眠呼吸暂停综合征, 低氧血症, 麻醉安全性

Abstract:

Objective ·To investigate the anesthetic effect of PetCO₂ monitoring nasopharyngeal airway on preventing hypoxia in patients with obstructive sleep apnea syndrome (OSAS) during magnifying endoscopy. Methods ·Eighty OSAS patients who underwent magnifying endoscopy anesthesia in Xuchang Central Hospital of Henan Province from February to June 2023 were randomly divided into PetCO₂ monitoring nasopharyngeal airway group (group T) and traditional nasopharyngeal airway group (group B), with 40 cases in each group. General information, perioperative data and total anesthetic dosage of the two groups of patients were collected and compared. The systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR) and pulse oxygen saturation (SpO₂) of the two groups of patients before anesthesia (T0), at the time of entering the endoscopy (T1), 3 min after entering the endoscopy (T2), 10 min after entering the endoscopy (T3) and at the end of endoscopy (T4) were observed and recorded, respectively. The incidence of body movement and hypoxemia, and the effects of preventing hypoxia (including mask ventilation, jaw-lift support and chest compressions to assist breath) of the two groups of patients were recorded. Results ·There were no significant differences in general information, perioperative data and total anesthetic dosage between the two groups. At T1 and T2, SpO₂ in group T was higher than that in group B (T1: P=0.041,T2: P=0.012), and there was no statistically significant difference in SBP, DBP and HR between the groups; at other time points, there was no statistically significant difference in the four indicators between the two groups. Compared with group B, the incidences of body movement, hypoxemia, mask ventilation, jaw-lift support and chest compressions to assist breath in group T were all decreased (all P=0.000). Conclusion ·PetCO₂ monitoring nasopharyngeal airway can reduce the incidence of hypoxia during magnifying endoscopy in patients with OSAS, with minimal adverse events. Also, it can detect the status of lung ventilation in time, guide clinical intervention, reduce complications and improve the safety of magnifying endoscopy anesthesia.

Key words: PetCO₂ monitoring nasopharyngeal airway, magnifying endoscopy, obstructive sleep apnea syndrome (OSAS), hypoxemia, anesthesia safety

中图分类号:

R614

吴雷, 夏一梦. PetCO₂监测型鼻咽通气道在阻塞型睡眠呼吸暂停综合征患者胃镜精查麻醉中的应用研究[J]. 上海交通大学学报（医学版）, 2023, 43(12): 1542-1547.

WU Lei, XIA Yimeng. Anesthetic application of PetCO₂ monitoring nasopharyngeal airway to magnifying endoscopy in patients with obstructive sleep apnea syndrome[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2023, 43(12): 1542-1547.

图/表 4

参考文献 16

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Item	Group B (n=40)	Group T (n=40)	P value
Age/year	44.55±9.21	45.35±9.19	0.350
Gender (male/female)/n	31/9	32/8	0.792
BMI/(kg·m^-2)	30.93±1.90	30.78±2.06	0.369
ASA classification (Ⅰ/Ⅱ)/n	5/35	10/30	0.152
Mallampati classification (Ⅰ/Ⅱ/Ⅲ/Ⅳ) /n	5/15/19/1	8/11/20/1	0.718

Item	Group B (n=40)	Group T (n=40)	P value
Age/year	44.55±9.21	45.35±9.19	0.350
Gender (male/female)/n	31/9	32/8	0.792
BMI/(kg·m^-2)	30.93±1.90	30.78±2.06	0.369
ASA classification (Ⅰ/Ⅱ)/n	5/35	10/30	0.152
Mallampati classification (Ⅰ/Ⅱ/Ⅲ/Ⅳ) /n	5/15/19/1	8/11/20/1	0.718

Item	Group B (n=40)	Group T (n=40)	P value
Perioperative data
Anesthesia duraion/min	25.08±3.24	23.85±3.82	0.061
Surgery duration/min	23.78±3.32	22.50±3.82	0.063
Recovery duration/min	8.28±1.87	6.65±1.89	0.069
Total fluid volume/mL	242.50±50.07	248.75±56.03	0.312
Anesthetic dosage
Propofol/mg	420.65±44.98	406.35±47.19	0.081
Remifentanyl/μg	19.73±4.93	19.50±4.77	0.407

Item	Group B (n=40)	Group T (n=40)	P value
Perioperative data
Anesthesia duraion/min	25.08±3.24	23.85±3.82	0.061
Surgery duration/min	23.78±3.32	22.50±3.82	0.063
Recovery duration/min	8.28±1.87	6.65±1.89	0.069
Total fluid volume/mL	242.50±50.07	248.75±56.03	0.312
Anesthetic dosage
Propofol/mg	420.65±44.98	406.35±47.19	0.081
Remifentanyl/μg	19.73±4.93	19.50±4.77	0.407

Time	Item	Group B (n=40)	Group T (n=40)	P value
T0	SBP/mmHg	142.35±8.47	144.33±7.74	0.140
	DBP/mmHg	77.85±9.18	80.18±6.55	0.110
	HR/(beat·min^-1)	77.95±6.94	76.71±6.71	0.221
	SpO₂/%	97.75±0.44	97.73±0.45	0.413
T1	SBP/mmHg	125.61±6.24	125.35±5.89	0.431
	DBP/mmHg	72.13±5.63	73.68±4.86	0.090
	HR/(beat·min^-1)	72.80±6.71	72.88±6.22	0.480
	SpO₂/%	93.65±1.67	94.28±1.48	0.041
T2	SBP/mmHg	124.20±6.30	123.73±5.66	0.363
	DBP/mmHg	69.23±7.45	69.75±5.89	0.360
	HR/(beat·min^-1)	69.83±5.77	70.05±5.58	0.434
	SpO₂/%	92.53±1.84	93.33±1.33	0.012
T3	SBP/mmHg	119.23±4.20	119.03±4.62	0.422
	DBP/mmHg	70.60±7.41	68.20±5.93	0.063
	HR/(beat·min^-1)	73.70±6.03	71.48±7.01	0.071
	SpO₂/%	94.18±2.12	94.05±1.66	0.390
T4	SBP/mmHg	122.85±4.93	122.73±4.97	0.460
	DBP/mmHg	68.30±6.01	69.13±6.31	0.281
	HR/(beat·min^-1)	73.88±5.73	74.48±5.68	0.322
	SpO₂/%	98.38±0.74	98.30±0.88	0.341

PetCO₂监测型鼻咽通气道在阻塞型睡眠呼吸暂停综合征患者胃镜精查麻醉中的应用研究

Anesthetic application of PetCO₂ monitoring nasopharyngeal airway to magnifying endoscopy in patients with obstructive sleep apnea syndrome

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Metrics

Item	Group B (n=40)	Group T (n=40)
Mask ventilation/n(%)	25 (62.5)	10 (25.0)
Jaw-lift support/n(%)	37 (92.5)	19 (47.5)
Chest compressions to assist breath/n(%)	30 (75.0)	12 (30.0)
Hypoxemia/n(%)	34 (85.0)	15 (37.5)
Body movement/n(%)	19 (47.5)	6 (15.0)