诊断学理论与实践 ›› 2020, Vol. 19 ›› Issue (06): 594-599.doi: 10.16150/j.1671-2870.2020.06.009
收稿日期:
2020-10-14
出版日期:
2020-12-25
发布日期:
2022-07-14
通讯作者:
王筱婧
E-mail:yoyowxj@163.com
基金资助:
LIN Yuxuan, ZHAO Yanhua, WANG Xiaojing()
Received:
2020-10-14
Online:
2020-12-25
Published:
2022-07-14
Contact:
WANG Xiaojing
E-mail:yoyowxj@163.com
摘要:
目的: 研究丙泊酚镇静下无痛胃镜检查过程中,患者的低氧血症发生率及其危险因素,为制定临床预防策略提供理论依据。方法: 2017年11月至2018年2月,连续纳入共1 000例行丙泊酚镇静下无痛胃镜检查的门诊患者,记录术中是否发生低氧血症及镇静相关不良事件。将患者分为发生低氧血症和未发生低氧血症2组,记录患者的基本资料和无痛胃镜检查及麻醉的相关信息。结果: 1 000例患者行丙泊酚镇静下无痛胃镜检查过程中,低氧血症发生率为8.4%,有高血压病史、打鼾史、年龄大、体质量指数(body mass index, BMI)高、 美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级高、甲颏距离小、胃镜进镜次数多、丙泊酚总用量大和基础血氧饱和度低是其发生低氧血症的危险因素(P<0.05),其中年龄大(45~65岁,OR=2.903,95%CI为1.399~6.026;>65岁,OR=5.495,95%CI为2.124~14.211);丙泊酚总用量大(80~100 mg, OR=3.289, 95%CI为1.215~8.906;101~120 mg,OR=5.881,95%CI为1.964~17.615;>120 mg,OR=7.717,95%CI为2.664~22.351);基础血氧饱和度低(<95%,OR=3.327,95%CI为1.173~9.439)是无痛胃镜检查过程中发生低氧血症的独立危险因素。结论: 老年患者(>65岁)、丙泊酚总用量较大(>120 mg)以及术前基础血氧饱和度低(<95%)的患者,在无痛胃镜检查过程中发生低氧血症的风险增高,医师应积极主动对其进行预防和干预。
中图分类号:
林雨轩, 赵延华, 王筱婧. 丙泊酚镇静下无痛胃镜术中低氧血症的发生率及危险因素分析[J]. 诊断学理论与实践, 2020, 19(06): 594-599.
LIN Yuxuan, ZHAO Yanhua, WANG Xiaojing. Risk factors for hypoxia during performing gastroscopy with propofol sedation[J]. Journal of Diagnostics Concepts & Practice, 2020, 19(06): 594-599.
表1
计数资料单因素分析
指标 | 低氧血症 (n=84) | 非低氧血症 (n=915) | χ2值 | P值 |
---|---|---|---|---|
性别 | 0.366 | 0.545 | ||
男 | 37(44.0) | 372(40.7) | ||
女 | 47(56.0) | 543(59.3) | ||
高血压 | 18.875 | <0.001 | ||
有 | 25(29.8) | 115(12.6) | ||
无 | 59(70.2) | 800(87.4) | ||
糖尿病 | 2.137 | 0.144 | ||
有 | 7(8.3) | 43(4.7) | ||
无 | 77(91.7) | 872(95.3) | ||
心脏病 | 0.060 | 0.807 | ||
有 | 1(1.2) | 14(1.5) | ||
无 | 83(98.8) | 901(98.5) | ||
打鼾史 | 11.517 | 0.001 | ||
有 | 33(39.3) | 208(22.7) | ||
无 | 51(60.7) | 707(77.3) | ||
OSAHS | - | - | ||
有 | 0 | 0 | ||
无 | 84(100) | 915(100) |
表2
计量资料单因素分析
指标 | 低氧血症 (n=84) | 非低氧血症 (n=915) | Z值 | P值 |
---|---|---|---|---|
年龄(岁) | -6.913 | <0.001 | ||
<45 | 15(17.9) | 423(46.2) | ||
45~65 | 52(61.9) | 388(42.4) | ||
>65 | 17(20.2) | 104(11.4) | ||
BMI(kg/m2) | -5.710 | <0.001 | ||
<18.5 | 2(2.4) | 79(8.6) | ||
18.5~28.0 | 63(75.0) | 789(86.2) | ||
>28.0 | 19(22.6) | 47(5.2) | ||
ASA分级 | -5.511 | <0.001 | ||
Ⅰ级 | 33(39.3) | 631(69.0) | ||
Ⅱ级 | 51(60.7) | 284(31.0) | ||
Ⅲ级 | 0 | 0 | ||
Mallampati分级 | -0.759 | 0.448 | ||
Ⅰ | 29(34.5) | 340(37.2) | ||
Ⅱ | 36(42.9) | 398(43.5) | ||
Ⅲ | 14(16.7) | 149(16.3) | ||
Ⅳ | 5(5.9) | 28(3.1) | ||
张口度 | -0.607 | 0.544 | ||
1指 | 0 | 0 | ||
2指 | 0 | 4(0.4) | ||
3指 | 84(100) | 911(99.6) | ||
甲颏距离(cm) | -7.414 | <0.001 | ||
>6.5 | 62(73.8) | 870(95.1) | ||
6.0~6.5 | 20(23.8) | 37(4.0) | ||
<6.0 | 2(2.4) | 8(0.9) | ||
胃镜进镜次数 | -3.063 | 0.002 | ||
1 | 78(92.9) | 897(98.0) | ||
2 | 5(6.0) | 9(1.0) | ||
3 | 1(1.2) | 8(1.0) | ||
胃镜检查时间(min) | -1.859 | 0.063 | ||
<5 | 28(33.3) | 375(41.0) | ||
5~10 | 51(60.7) | 531(58.0) | ||
>10 | 5(6.0) | 9(1.0) | ||
丙泊酚总用量(mg) | -3.798 | <0.001 | ||
<80 | 6(7.1) | 151(16.5) | ||
80~100 | 31(36.9) | 423(46.3) | ||
101~120 | 15(17.9) | 138(15.1) | ||
>120 | 32(38.1) | 200(21.9) | ||
基础血氧饱和度(%) | -2.392 | 0.017 | ||
>97 | 51(60.7) | 658(71.9) | ||
95~97 | 26(31.0) | 229(25.0) | ||
<95 | 7(8.3) | 27(3.1) |
表3
Logistic回归分析
指标 | β | SE | Wald | OR | 95%CI | P值 | |
---|---|---|---|---|---|---|---|
下限 | 上限 | ||||||
年龄(岁) | 12.564 | 0.002 | |||||
<45 | 参照 | ||||||
45~65 | 1.066 | 0.373 | 8.182 | 2.903 | 1.399 | 6.026 | 0.004 |
>65 | 1.704 | 0.485 | 12.350 | 5.495 | 2.124 | 14.211 | <0.001 |
甲颏距离(cm) | 11.246 | 0.004 | |||||
>6.5 | 参照 | ||||||
6.0~6.5 | 1.271 | 0.380 | 11.181 | 3.565 | 1.692 | 7.511 | 0.001 |
<6.0 | 0.162 | 0.940 | 0.030 | 1.176 | 0.186 | 7.415 | 0.863 |
丙泊酚总用量(mg) | 17.007 | 0.001 | |||||
<80 | 参照 | ||||||
80~100 | 1.191 | 0.508 | 5.487 | 3.289 | 1.215 | 8.906 | 0.019 |
101~120 | 1.772 | 0.560 | 10.020 | 5.881 | 1.964 | 17.615 | 0.002 |
>120 | 2.043 | 0.543 | 14.184 | 7.717 | 2.664 | 22.351 | <0.001 |
基础血氧饱和度(%) | 6.355 | 0.042 | |||||
>97 | 参照 | ||||||
95~97 | 0.463 | 0.293 | 2.497 | 1.588 | 0.895 | 2.819 | 0.114 |
<95 | 1.202 | 0.532 | 5.106 | 3.327 | 1.173 | 9.439 | 0.024 |
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