诊断学理论与实践

诊断学理论与实践 ›› 2020, Vol. 19 ›› Issue (06): 594-599.doi: 10.16150/j.1671-2870.2020.06.009

• 论著 • 上一篇    下一篇

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

林雨轩, 赵延华, 王筱婧()   

  1. 上海交通大学医学院附属仁济医院麻醉科,上海 200127
  • 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:
    上海市卫生健康委员会科研课题(201940077)

Risk factors for hypoxia during performing gastroscopy with propofol sedation

LIN Yuxuan, ZHAO Yanhua, WANG Xiaojing()   

  1. Department of Anesthesiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
  • Received:2020-10-14 Online:2020-12-25 Published:2022-07-14
  • Contact: WANG Xiaojing E-mail:yoyowxj@163.com

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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。

关键词: 胃镜, 镇静, 低氧血症, 丙泊酚, 危险因素

Abstract:

Objective: To investigate the incidence and risk factors of hypoxia during performing gastroscopy with propofol sedation and provide theoretical basis for preventing hypoxia. Methods: From November 2017 to February 2018, a total of 1 000 outpatients undergoing routine gastroscopy with propofol sedation were enrolled,and the incidence of hypoxia and the other adverse events were recorded during performing gastroscopy. The patients were divided into two groups: hypoxia group and non-hypoxia group, and the general information, gastroscopy procedure and anesthesia related information were analyzed. Results: The incidence of hypoxia was 8.4% during gastroscopic examination. It revealed that the history of hypertension and snoring, elderly age, body mass index (BMI), American Society of Anesthesiologists (ASA) classification, shorter thyromental distance, number of passing the gastroscope through the pharyngeal, high dose of propofol and low baseline of SpO2 were risk factors for occurrence of hypoxia during performing gastroscopy with propofol sedation (P<0.05). Age (45-65 years old, OR=2.903, 95% CI: 1.399-6.026,>65 years old, OR=5.495, 95% CI: 2.124-14.211), the dose of propofol (80-100 mg, OR=3.289, 95%CI: 1.215-8.906; 101-120 mg, OR=5.881, 95%CI: 1.964-17.615; >120 mg, OR=7.717, 95%CI: 2.664-22.351) and lower baseline of SpO2 (<95%, OR=3.327, 95% CI:1.173-9.439) were independent risk factors for hypoxia. Conclusions: Elderly patients (over 65 years old), the patients obtaining high dose of propofol (>120 mg) and with lower baseline SpO2 (<95%) have increased risk of hypoxia during gastroscopic examination with propofol sedation, and the hypoxia should be actively prevented and interfered.

Key words: Gastroscopy, Sedation, Hypoxia, Propofol, Risk factors

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