体位因素对肥胖患者无痛胃镜检查术中咽喉反流的影响
Effect of different head height lateral decubitus positions on painless gastroscopy in obese patients for Laryngopharyngeal reflux
田小威 1贺亚楠 1马作军 1王冬梅 2贾利军1
作者信息
- 1. 郑州大学第一附属医院麻醉与围手术期及疼痛医学部,河南郑州 450002
- 2. 郑州大学第一附属医院消化内科医学部,河南郑州 450002
- 折叠
摘要
目的 探讨体位因素对肥胖患者无痛胃镜检查(Painless Gastroscopy)术中咽喉反流(Laryngopharyngeal Reflux)的影响.方法 选择郑州大学第一附属医院择期拟行无痛胃镜检查术的患者120例,性别不限,年龄18～64岁,BMI 28.0～32.0 kg/m2,ASA分级Ⅰ或Ⅱ级,采用随机数字表法分为3组(n=40):头高15°左侧卧位组(H15°组)、头高30°左侧卧位组(H30°组)和左侧卧位(C组)°在胃镜检查围手术期间,H15°组床头端抬高15°;H30°组床头端抬高30°;对照组床头端无抬高,常规进行胃镜下检查和/或活组织检查,在术中反流即刻或术毕检测咽喉腔粘液胃蛋白酶,患者苏醒后转入麻醉恢复室(PACU)进行麻醉恢复期监护.记录术前、术中和PACU期的心率(HR)、血压(BP)和血氧饱和度(SpO2);观察术中咽喉反流、呛咳、体动、低氧血症、低血压和心动过速的发生情况,记录PACU驻留时间、不良反应、舒适度评分和焦虑评分.结果 与C组比较,H15°组和H30°组术中咽喉反流发生率较低,呛咳发生率较低,低氧血症发生率较低(P＜0.001).H15°组和H30°组比较,各指标差异无统计学意义(P＞0.05).结论 头高15°和头高30°左侧卧位均是一种降低肥胖患者镇静状态下咽喉反流的有效措施.
Abstract
Objective To investigate the effect of different head high lateral decubitus positions on laryngopharynge-al reflux in patients undergoing painless gastroscopy.Methods A total of 120 patients with the history of acid reflux underwent elective painless gastroscopy,with no gender limit,BMI 28.0～32.0 kg/m2,ASA grade 1 or Ⅱ.They were divided into 3 groups(n=40)using the random number table method:head height 15 Left decubitus group(H15° group),head height 30 Left decubitus group(H30°group)and the control group in the left decubitus position(H0° group).Before gastroscopy,H15° group with 15° heads elevated during the perioperative period H30°.The group had 30° heads elevated during the perioperative period.In the observation group,the patients were placed in the left decubi-tus position(no head elevation)during the perioperative period.After the operation,he was transferred to the Anesthe-sia Recovery Unit(PACU).The number of coughs,reflux and oxygen saturation,heart rate and blood pressure were re-corded before surgery,admission to the examination room,anesthesia induction,5 min after the start of surgery,at the end of examination and during the anesthesia recovery period.Results With H0° Group comparison,H15° Group and H30°.In the group,the incidence of intraoperative throat reflux,cough and hypoxemia was low(P＜0.05).H15°Group and H30°Group comparison,there was no significant difference between the indicators(P＞0.05).Conclusion The head height 15°Left lateral decubitus position is effective in reducing the incidence of laryngopharyngeal reflux during painless gastroscopy in obese patients.
关键词
肥胖/头高侧卧位/咽喉腔黏液/反流/呛咳/低氧血症Key words
obesity/head high lateral position/throat cavity mucus/reflux/cough/hypoxemia引用本文复制引用
基金项目
河南省医学科技攻关计划项目(2018020144)
出版年
2024
NETL
NSTL
万方数据