文章摘要
快充式经鼻湿化高流量通气在结直肠息肉无痛内镜下黏膜切除术中的应用
Application of transnasal humidified rapid-insufflation ventilatory exchange in painless endoscopic mucosal resection of colorectal polyps
  
DOI：10.12089/jca.2023.11.006
中文关键词: 内镜下黏膜切除术  镇静镇痛  快充式经鼻高流量通气  胃进气  低氧
英文关键词: Endoscopic mucosal resection  Sedation and analgesia  Transnasal humidified rapid-insufflation ventilatory exchange  Gastric intake  Hypoxia
基金项目:南京市医学科技发展资金资助（QRX17019，YKK18105）;南京市卫生科技发展专项资金重点项目（ZKX22030）；江苏省六大人才高峰项目（WSW-106）
作者单位E-mail
程丹 210000,南京医科大学附属南京医院（南京市第一医院）麻醉疼痛与围术期医学科  
谭其莲 210000,南京医科大学附属南京医院（南京市第一医院）麻醉疼痛与围术期医学科  
蒋宇智 210000,南京医科大学附属南京医院（南京市第一医院）麻醉疼痛与围术期医学科  
蒋卫清 210000,南京医科大学附属南京医院（南京市第一医院）麻醉疼痛与围术期医学科  
陈利海 210000,南京医科大学附属南京医院（南京市第一医院）麻醉疼痛与围术期医学科  
郭姚邑 210000,南京医科大学附属南京医院（南京市第一医院）麻醉疼痛与围术期医学科  
姜帆 210000,南京医科大学附属南京医院（南京市第一医院）麻醉疼痛与围术期医学科  
冯悦 210000,南京医科大学附属南京医院（南京市第一医院）麻醉疼痛与围术期医学科  
斯妍娜 210000,南京医科大学附属南京医院（南京市第一医院）麻醉疼痛与围术期医学科 siyanna@njmu.edu.cn 
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中文摘要:
      
目的 观察快充式经鼻湿化高流量通气（THRIVE）对结直肠息肉无痛内镜下黏膜切除（EMR）术患者胃进气和SpO2的影响。
方法 选择行无痛结直肠息肉EMR术患者70例，男36例，女34例，年龄18～64岁，BMI 18～25 kg/m2，ASA Ⅰ或Ⅱ级。采用随机数字表法将患者分为两组：高流量吸氧组（T组）和常规吸氧组（C组），每组35例。T组给予THRIVE，C组经鼻常规吸氧，麻醉期间维持BIS 50～65。采用床旁胃超声观察患者的胃内容和胃进气。记录术前平卧位下静息5 min（静息5 min）、进镜后1 min、进镜至回盲瓣时和术毕时的HR、SpO2，静息5 min、进镜至回盲瓣和术毕时的PaCO2、PaO2 和pH，静息5 min和术毕时胃进气和饱胃发生情况、胃窦部横截面积（CSA）。记录麻醉期间轻度低氧、中度低氧、重度低氧的发生情况。记录手术时间、术中丙泊酚用量、瑞芬太尼给药次数、PACU停留时间和术中输液量，低血压、高血压、心动过缓、反流误吸、术后恶心呕吐等不良反应发生情况，消化科内镜医师和患者满意度评分。
结果 与C组比较，T组进镜后1 min时SpO2明显升高（P＜0.05），进镜至回盲瓣和术毕时PaCO2明显降低（P＜0.05），轻度低氧和中度低氧发生率明显降低（P<0.05）。两组静息5 min和术毕时均未出现胃进气阳性和饱胃。两组不良反应发生率和患者满意度评分差异无统计学意义。T组内镜医师满意度评分明显高于C组（P＜0.05）。
结论 与常规鼻导管吸氧比较，THRIVE不会引起高碳酸血症，不影响胃进气和胃内容，可以降低无痛EMR术患者轻中度低氧的发生，不增加反流误吸的风险，消化科内镜医师满意度更高。
英文摘要:
      
Objective To observe the effects of transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) on gastric air intake and SpO2 in patients with painless endoscopic mucosal resection (EMR) of colorectal polyps.
Methods Seventy patients with painless colorectal polyps EMR, 36 males, 34 females, aged 18-64 years, BMI 18-25 kg/m2, ASA Ⅰor Ⅱ. The patients were divided into two groups: high-flow oxygen inhalation group (group T) and conventional oxygen inhalation group (group C) by random number table method, 35 cases in each group. Patients in group T were given THRIVE oxygen inhalation, and patients in group C were routinely inhaled oxygen through the nose. During anesthesia, the BIS value was maintained at 50-65. Bedside gastric ultrasonography was used to observe the gastric content and gastric air intake of patients. The HR and resting SpO2 in the supine position were recorded 5 minutes before the surgery (rest for 5 minutes), 1 minute after entering the endoscope, when entering the endoscope to the ileocecal valve, and at the end of the surgery. The PaCO2, PaO2 and pH values were recorded 5 minutes before surgery, when entering the endoscope to the ileocecal valve, and at the end of the surgery, so were gastric intake and satiety, and antral cross-sectional area (CSA) for 5 minutes before surgery and after surgery. The occurrence of mild, moderate, and severe hypoxia during anesthesia were recorded. The operation time, the amount of propofol used during the operation, the number of dosage times of remifentanil, PACU residence time, and infusion during surgery, the occurrence of adverse reactions such as hypotension, hypertension, bradycardia, reflux aspiration, postoperative nausea and vomiting, and the satisfaction score of digestive endoscopy physicians and patients were recrded.
Results Compared with group C, SpO2 in group T was significantly increased 1 minutes after entering the endoscope (P < 0.05), and PaCO2 was significantly decreased at the time of entering the endoscope to the ileocecal valve and the end of the surgery (P < 0.05), the incidence of mild and moderate hypoxia was significantly reduced in group T (P < 0.05). No positive gastric air intake and full stomach were found in both groups at rest for 5 minutes and after the surgery. There was no significant difference in the incidence of adverse reactions and patient satisfaction scores between the two groups. The satisfaction score of endoscopists in group T was significantly higher than that in group C (P < 0.05).
Conclusion Compared with conventional nasal catheter oxygen inhalation, THRIVE ventilation does not cause hypercapnia or affect gastric intake and stomach content, does reduce the occurrence of mild to moderate hypoxia in patients undergoing painless EMR, does not increase the risk of reflux aspiration, and has a higher satisfaction of digestive endoscopy physicians.
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