背景:通过持续监测潮气末二氧化碳浓度,二氧化碳监测可以早期发现异常通气或呼吸暂停。这个随机的,对照研究探讨了二氧化碳监测早期干预对轻度肥胖患者食管胃十二指肠镜(EGD)和结肠镜下镇静的缺氧发生率的影响。
方法:这是一个单中心,随机化,单盲,并行分配,对照试验。接受EGD镇静和结肠镜检查的轻度肥胖患者(28kg/m2≤BMI<40kg/m2)被随机分配到标准或二氧化碳监测组。两组均使用标准心肺监测设备,并且在二氧化碳描记术组中进行了额外的二氧化碳描记术.如果镇静期间肺泡通气不足,按顺序(a-e)进行五次干预:a:增加氧气流量(5L/min);b:抬起下巴或下颌推力动作;c:放置鼻咽通气道和抬起下巴;d:面罩正压通气,和e:带导管插入的呼吸机辅助通气。主要结果是缺氧的发生率(SpO2<90%,每组≥10s)。次要结局包括严重缺氧的发生率(SpO2≤85%),亚临床呼吸抑制(90%≤SpO2<95%),干预措施,运行期间的最小SpO2,患者满意度,内镜医师满意度,和其他不良事件的麻醉镇静。
结果:本研究纳入了228例患者(二氧化碳监测组=112;标准组=113;排除3例患者)。二氧化碳描记术组的缺氧发生率明显低于标准组(13.4%vs.30.1%,P=0.002)。二氧化碳监测组的亚临床呼吸抑制高于标准组(30.4%vs.17.7%,P=0.026)。二氧化碳监测组仅有5.4%的严重缺氧发生率,而标准组为14.2%(P=0.026)。在镇静期间,二氧化碳浓度和标准组中的96和34个人,分别,接受了干预。两组间最后一次术中干预次数差异有统计学意义(P<0.0001)(a:47vs.1,b:46vs.26,c:2vs.5,d:1vs.2,e:0vs.0).两组术中最低SpO2无显著性差异,患者满意度,或内窥镜医师满意度评级。两组麻醉镇静不良事件比较差异无统计学意义。
结论:EGD镇静和结肠镜检查期间的二氧化碳监测可以检测轻度肥胖患者在SpO2降低之前的呼吸暂停和呼吸模式改变。在此时间范围内给予患者有效的干预措施,降低了患者缺氧和严重缺氧的发生率。
背景:经齐鲁医院医学伦理委员会(田辉教授)批准,山东大学((Ke)LunAudit2021(186))于2021年7月15日。该研究已注册(https://www。chictr.org.cn)2021年10月23日(ChiCTR2100052234)。使用CONSORT语句进行设计和报告。
By continually monitoring end-tidal carbon dioxide concentrations,
capnography can detect abnormal ventilation or apnoea early. This randomized, controlled study explored the effect of early intervention with
capnography on the incidence of hypoxia in mildly obese patients undergoing sedation for esophagogastroduodenoscopy (EGD) and colonoscopy.
This is a single-center, randomized, single-blind, parallel-assignment, controlled trial. Mildly obese patients (28 kg/m2 ≤ BMI < 40 kg/m2) undergoing sedation for EGD and colonoscopy were randomly assigned to either the standard or capnography group. Standard cardiopulmonary monitoring equipment was used in both groups, and additional
capnography was performed in the
capnography group. In the event of inadequate alveolar ventilation during sedation, five interventions were administered in sequence (a-e) : a: increasing oxygen flow (5 L/min); b: a chin lift or jaw thrust maneuver; c: placement of the nasopharyngeal airway and chin lift; d: mask positive-pressure ventilation, and e: ventilator-assisted ventilation with tube insertion. The primary outcome was the incidence of hypoxia (SpO2 < 90%, ≥ 10 s) in each group. The secondary outcomes included the incidence of severe hypoxia (SpO2 ≤ 85%), subclinical respiratory depression (90% ≤ SpO2 < 95%), interventions, minimum SpO2 during operation, patient satisfaction, endoscopist satisfaction, and other adverse events of anesthesia sedation.
228 patients were included (capnography group = 112; standard group = 113; three patients were excluded) in this study. The incidence of hypoxia was significantly lower in the
capnography group than in the standard group (13.4% vs. 30.1%, P = 0.002). Subclinical respiratory depression in the capnography group was higher than that of the standard group (30.4% vs. 17.7%, P = 0.026). There was only a 5.4% incidence of severe hypoxia in the capnography group compared with 14.2% in the standard group (P = 0.026). During sedation, 96 and 34 individuals in the capnography and standard groups, respectively, underwent the intervention. There was a statistically significant difference (P < 0.0001) in the number of the last intraoperative intervention between the two groups ( a:47 vs. 1, b:46 vs. 26, c:2 vs. 5, d:1 vs. 2, e:0 vs. 0 ). No significant differences were found between the two groups in terms of minimum SpO2 during operation, patient satisfaction, or endoscopist satisfaction rating. There was no statistically significant difference in adverse events of anesthesia sedation between the two groups.
Capnography during sedation for EGD and colonoscopy allows for the detection of apnea and altered breathing patterns in mildly obese patients before SpO2 is reduced. Effective intervention measures are given to patients within this time frame, which reduces the incidence of hypoxia and severe hypoxia in patients.
Ethical approval was granted by the Medical Ethics Committee (Chairperson Professor Tian Hui) of Qilu Hospital, Shandong University ((Ke) Lun Audit 2021 (186)) on 15/07/2021. The study was registered ( https://www.chictr.org.cn ) on 23/10/2021(ChiCTR2100052234). Designed and reported using CONSORT statements.