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| 高流量鼻导管吸氧对无痛胃肠镜检查术中低氧的影响及术中低氧的危险因素分析 |
| Effect on high flow nasal oxygen inhalation on intraoperative hypoxia during painless gastroscopy and colonoscopy surgery and analysis of risk factors for intraoperative hypoxia |
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| DOI：10.12089/jca.2025.10.002 |
| 中文关键词: 高流量鼻导管吸氧 无痛胃肠镜 低氧 |
| 英文关键词: High flow nasal oxygen Painless gastroscopy and colonoscopy Hypoxia |
| 基金项目:上海市卫生健康委员会卫生行业临床研究专项（201940077） |
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| 摘要点击次数: 2072 |
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| 中文摘要: |
目的：探讨高流量鼻导管吸氧(HFNO)用于预防和改善无痛胃肠镜检查术中低氧发生的有效性，以及分析普通鼻导管吸氧下无痛胃肠镜检查患者发生低氧的危险因素。
方法：选择2022年6—8月择期行无痛胃肠镜检查患者1 000例，男461例，女539例，年龄18～70岁，ASA Ⅰ或Ⅱ级。采用随机数字表法将患者分为两组：普通鼻导管吸氧组（C组）和HFNO组（H组）。两组患者麻醉前均给予氧气5 L/min，吸入5 min，麻醉镇静意识消失后，C组氧流量保持不变，H组氧流量增加至30 L/min。记录术中轻度低氧、中重度低氧、亚临床呼吸抑制的发生情况。记录镇静持续时间、丙泊酚总用量、Mallampati分级和Ramsay镇静评分。采用多因素Logistic回归分析普通鼻导管吸氧下无痛胃肠镜检查患者发生低氧的危险因素。
结果：与C组比较，H组轻度低氧、中重度低氧、低氧总发生率和亚临床呼吸抑制发生率明显降低（P<0.05）。多因素Logistic回归分析显示，BMI增大（OR=6.837， 95%CI 1.591～29.375，P=0.010）、Mallampati分级升高（OR=95.455，95%CI 2.115～4 307.237，P=0.019）和Ramsay镇静评分升高（OR=151.183，95%CI 10.650～2 146.192，P<0.001）是普通鼻导管吸氧下无痛胃肠镜检查发生低氧的危险因素。
结论：HFNO可减少无痛胃肠镜检查患者低氧的发生并且预防亚临床呼吸抑制的发生。对于BMI较大、Mallampati分级较高、需要深度镇静的患者，建议使用HFNO减少术中低氧的发生，提高临床安全性。 |
| 英文摘要: |
Objective: To investigate the efficacy of high flow nasal oxygen (HFNO) inhalation for preventing and improving hypoxia during painless gastroscopy, and to analyze the risk factors for intraoperative hypoxia during common nasal cannula oxygen inhalation.
Methods: A total of 1 000 patients who underwent elective painless gastroscopy from June 2022 to August 2022 were selected, 461 males and 539 females, aged 18-70 years, ASA physical status Ⅰ or Ⅱ. The patients were randomly divided into two groups: the common nasal cannula oxygen inhalation group (group C) and the HFNO inhalation group (group H). Both groups of patients were given oxygen at 5 L/min for 5 minutes before anesthesia, and after the loss of consciousness, the flow of oxygen in group C remained unchanged, and the flow of oxygen in group H increased to 30 L/min. The incidence of mild desaturation, moderate to severe desaturation, and subclinical respiratory depression were recorded. Duration of sedation, total dose of propofol, Mallampati grade, and Ramsay sedation-depth score were recorded. Multivariate logistic regression analysis was used to identify risk factors for hypoxia in the patients undergoing painless gastroscopy under common nasal cannula oxygen inhalation.
Results: Compared with group C, the incidence mild hypoxia, moderate to severe hypoxia, total hypoxia rate, and cubclinical respiratory depression in group H were signifcantly decreased (P < 0.05). Multivariate logistic regression analysis demonstrated that BMI increased (OR = 6.837, 95% CI 1.591-29.375, P = 0.010), Mallampati classification increased (OR = 95.455, 95% CI 2.115-4 307.237, P = 0.019), and Ramsay sedation depth scores increased (OR = 151.183, 95% CI 10.650-2 146.192, P < 0.001) were the risk factors for hypoxia during painless gastrointestinal endoscopy under common nasal cannula oxygen inhalation.
Conclusion: HFNO therapy reduces the incidence of intraoperative hypoxia and prevents subclinical respiratory depression in patients undergoing painless gastroscopy. For patients with high BMI, elevated Mallampati classification, or requiring deep sedation, HFNO is recommended to reduce intraoperative hypoxia and enhance clinical safety. |
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