文章摘要
内镜专用口咽通气道在无痛胃镜中的应用
Application of the innovative endoscopic oropharyngeal airway in painless gastroscopy
  
DOI：10.12089/jca.2021.08.010
中文关键词: 无痛胃镜  口咽通气道  气道管理  低氧血症
英文关键词: Painless gastroscopy  Oropharynged airway  Airway management  Hypoxemia
基金项目:中国医学科学院中央级公益性科研院所基本科研业务费专项资金(2020-JKCS-007)
作者单位E-mail
章蔚 230001,合肥市,中国科学技术大学附属第一医院(安徽省立医院)麻醉科  
夏敏 230001,合肥市,中国科学技术大学附属第一医院(安徽省立医院)麻醉科 zw970979@163.com 
柴小青 230001,合肥市,中国科学技术大学附属第一医院(安徽省立医院)麻醉科  
陶磊 230001,合肥市,中国科学技术大学附属第一医院(安徽省立医院)麻醉科  
朱春 230001,合肥市,中国科学技术大学附属第一医院(安徽省立医院)麻醉科  
高坤坤 230001,合肥市,中国科学技术大学附属第一医院(安徽省立医院)麻醉科  
王胜 230001,合肥市,中国科学技术大学附属第一医院(安徽省立医院)麻醉科  
陈旭 230001,合肥市,中国科学技术大学附属第一医院(安徽省立医院)麻醉科  
吴昊 230001,合肥市,中国科学技术大学附属第一医院(安徽省立医院)麻醉科  
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中文摘要:
      
目的 观察内镜专用口咽通气道作为一种新型配套咬口与口咽通道的联合体在无痛胃镜应用中的安全性和有效性。
方法 选择行无痛胃镜检查患者200例，男89例，女111例，年龄22～64岁，BMI 16～30 kg/m2，ASA Ⅰ或Ⅱ级,随机分为两组：传统胃镜咬口组（C组）和内镜专用口咽通气道组（K组），每组100例。C组从传统胃镜咬口置入胃镜，K组从内镜专用口咽通气道配套咬口内置入口咽通气道，通过其置入胃镜。术中如有体动或呛咳时, 则追加丙泊酚0.2~0.4 mg/kg。记录检查前、胃镜达幽门时和苏醒时MAP、HR、SpO2；记录进镜时间、检查时间、苏醒时间、PACU停留时间、胃镜置入一次成功例数、胃镜置入难易度，记录患者舒适度、镜检医师满意度和不良反应发生情况。
结果 与C组比较，胃镜达幽门时K组SpO2明显增高（P<0.05）。与检查前比较，胃镜达幽门、苏醒时两组MAP明显降低、HR明显减慢，胃镜达幽门时C组SpO2明显降低（P<0.05）。与C组比较，K组胃镜一次置入成功率明显升高、胃镜进镜时间和PACU停留时间明显缩短、丙泊酚维持剂量明显减少、低血压发生率明显降低、患者舒适度和镜检医师满意度明显升高(P<0.05)。
结论 内镜专用口咽通气道可作为无痛胃镜的有效气道辅助装置，增加通气效率，降低麻醉药用量，加速无痛胃镜的实施，既确保了无痛胃镜的安全，也提高了无痛胃镜的效率。
英文摘要:
      
Objective To explore the safety and effectiveness of the innovative special airway for endoscopy as a combination of oral pad and oropharyngeal airway in patients undergoing painless gastroscopy.
Methods A total of 200 patients who underwent painless gastroscopy, 89 males and 111 females, aged 22-64 years, BMI 16-30 kg/m2, ASA physical stuats Ⅰ or Ⅱ were selected. The patients were randomly divided into two groups: group C and group K, 100 patients in each group. In group C before intravenous anesthesia, the traditional oral pad was placed into the mouth and properly fixed. In group K the oral pad of innovative airway (25-45 kg, medium size; 40-100 kg, large size) was used. In group C, the gastroscope was placed through the traditional oral pad. While in group K, the special pharyngeal airway was inserted through the innovative pad. Then the gastroscope went through the special pharyngeal airway and esophagus. During the gastroscopy, propofol 0.2-0.4 mg/kg was added if body movements or cough occurred. The hemodynamic indexes in different times (before gastroscopy, gastroscopy reached pylorus and waking up) were recorded. Safety indexes, adverse events and comfort scores of patients and physicians were observed and compared.
Results Compared with group C, SpO2 of the patients in the group K was higher at gastroscopy reached pylorus (P < 0.05). Compared with before gastroscopy, MAP and HR of the patients in the two groups was lower at gastroscopy reached pylorus and waking up (P < 0.05). Compared with before gastroscopy, SpO2 of the patients in group C was decreased (P < 0.05) at gastroscopy reached pylorus. Compared with group C, the successful rate of first gastroscope insertion for once in group K was higher (P < 0.05). Compared with group C, time to place endoscopy, propofol maintaining dose and PACU staying time of group K was decreased (P < 0.05). Compared with group C, the incidence of hypotension and hypoxia, the rate of SpO2 between 90% and 95% of group K was decreased (P < 0.05). The Satisfaction of patients and physicians of group K were higher than that of group C.
Conclusion The innovative oropharyngeal airway for endoscopy can safely and effectively help anethesiologists to manage the airway of patients undergoing painless gastroscopy, improving ventilation efficiency, and reducing narcotic drugs.
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