无痛消化内镜诊疗中低氧血症管理进展
Advances in the Management of Hypoxemia in Drug-Induced Sleep for Gastrointestinal Endoscopy
DOI: 10.12677/ACM.2023.1361414, PDF,   
作者: 胡文静, 户嘉祺：西安医学院，陕西 西安；韩 彬*：西安医学院第一附属医院麻醉科，陕西 西安
关键词: 低氧血症；消化内镜检查；镇静；Hypoxemia； Gastrointestinal Endoscopy； Sedation
摘要: 低氧血症是消化内镜诊疗中常见的镇静不良反应，由于镇静多在无人工气道建立下实施，且与内镜医生共用口咽部常使气道管理陷入被动。发生低氧血症时如未及时有效干预将会增加心脑血管事件的发生风险，导致非计划住院继而严重影响病人预后。本文从高危因素的评估，镇静深度的选择，呼吸监测和声门上通气设备的使用以及镇静药物等方面阐述了目前低氧血症防治的新进展。
Abstract: Hypoxemia is a common adverse effect of sedation in gastrointestinal endoscopy, as sedation is of-ten performed without an artificial airway and the sharing of the oropharynx with the endoscopist often leads to passive airway management. Failure to intervene effectively in hypoxemia increases the risk of cardiovascular and cerebrovascular events, leading to unplanned hospitalisation and a serious impact on patient prognosis. This article describes current developments in the manage-ment of hypoxemia in terms of assessment of risk factors, selection of sedation depth, use of respir-atory monitoring and supraglottic ventilation devices, and sedation drugs.
文章引用：胡文静, 户嘉祺, 韩彬. 无痛消化内镜诊疗中低氧血症管理进展[J]. 临床医学进展, 2023, 13(6): 10110-10116. https://doi.org/10.12677/ACM.2023.1361414

参考文献

[1] Zhou, S., Zhu, Z., Dai, W., et al. (2021) National Survey on Sedation for Gastrointestinal Endoscopy in 2758 Chinese Hospitals. British Journal of Anaesthesia, 127, 56-64. [Google Scholar] [CrossRef] [PubMed]
[2] Zhang, Q., Dong, Z., Jiang, Y., et al. (2020) The Impact of Sedation on Adenoma Detection Rate and Cecal Intubation Rate in Co-lonoscopy. Gastroenterology Research and Practice, 2020, Article ID: 3089094. [Google Scholar] [CrossRef] [PubMed]
[3] Bannert, C., Reinhart, K., Dunkler, D., et al. (2012) Sedation in Screening Colonoscopy: Impact on Quality Indicators and Complications. The American Journal of Gastroenterology, 107, 1837-1848. [Google Scholar] [CrossRef] [PubMed]
[4] Radaelli, F., Meucci, G., Sgroi, G., et al. (2008) Tech-nical Performance of Colonoscopy: The Key Role of Sedation/Analgesia and Other Quality Indicators. The American Journal of Gastroenterology, 103, 1122-1130. [Google Scholar] [CrossRef] [PubMed]
[5] Coté, G.A., Hovis, R.M., Ansstas, M.A., et al. (2010) In-cidence of Sedation-Related Complications with Propofol Use during Advanced Endoscopic Procedures. Clinical Gas-troenterology and Hepatology, 8, 137-142. [Google Scholar] [CrossRef] [PubMed]
[6] Qadeer, M.A., Lopez, A.R., Dumot, J.A., et al. (2011) Hypoxemia during Moderate Sedation for Gastrointestinal Endoscopy: Causes and Associations. Digestion, 84, 37-45. [Google Scholar] [CrossRef] [PubMed]
[7] Wani, S., Azar, R., Hovis, C.E., et al. (2011) Obesity as a Risk Factor for Sedation-Related Complications during Propofol-Mediated Sedation for Advanced Endoscopic Procedures. Gastrointes-tinal Endoscopy, 74, 1238-1247. [Google Scholar] [CrossRef] [PubMed]
[8] Cho, J., Choi, S.M., Park, Y.S., et al. (2020) Prediction of Cardio-pulmonary Events Using the STOP-Bang Questionnaire in Patients Undergoing Bronchoscopy with Moderate Sedation. Scientific Reports, 10, Article No. 14471. [Google Scholar] [CrossRef] [PubMed]
[9] Song, H.J. and Kim, J. (2022) Validity Analysis of Neck Cir-cumference as a Screening Test for Hypoxia Occurrence in Patients Undergoing Sedative Endoscopy. Healthcare, 10, Article 679. [Google Scholar] [CrossRef] [PubMed]
[10] Leslie, K., Allen, M.L., Hessian, E.C., et al. (2017) Safety of Sedation for Gastrointestinal Endoscopy in a Group of University-Affiliated Hospitals: A Prospective Cohort Study. British Journal of Anaesthesia, 118, 90-99. [Google Scholar] [CrossRef] [PubMed]
[11] Sharma, V.K., Nguyen, C.C., Crowell, M.D., et al. (2007) A National Study of Cardiopulmonary Unplanned Events after GI Endoscopy. Gastrointestinal Endoscopy, 66, 27-34. [Google Scholar] [CrossRef] [PubMed]
[12] (2018) Practice Guidelines for Moderate Procedural Sedation and Analgesia 2018: A Report by the American Society of Anesthesiologists Task Force on Moderate Procedural Sedation and Analgesia, the American Association of Oral and Maxillofacial Surgeons, American College of Radiology, American Dental Association, American Society of Dentist Anesthesiologists, and Society of Interventional Radiology. Anesthesi-ology, 128, 437-479.
[13] Early, D.S., Lightdale, J.R., Vargo, J.J., et al. (2018) Guidelines for Sedation and Anesthesia in GI Endoscopy. Gastrointestinal Endoscopy, 87, 327-337. [Google Scholar] [CrossRef] [PubMed]
[14] 国家消化内镜质控中心, 国家麻醉质控中心. 中国消化内镜诊疗镇静/麻醉操作技术规范[J]. 临床麻醉学杂志, 2019, 35(1): 81-84.
[15] Kang, S., Lu, J. and Zhou, H.M. (2021) Anesthetic Strategy for Obese Patients during Gastroscopy: Deep Sedation or Conscious Sedation? A Prospective Randomized Controlled Trial. Journal of Anesthesia, 35, 555-562.
[16] Lightdale, J.R., Goldmann, D.A., Feldman, H.A., et al. (2006) Microstream Capnography Improves Pa-tient monitOring during Moderate Sedation: A Randomized, Controlled Trial. Pediatrics, 117, e1170-e1178. [Google Scholar] [CrossRef] [PubMed]
[17] Qadeer, M.A., Vargo, J.J., Dumot, J.A., et al. (2009) Capnographic Monitoring of Respiratory Activity Improves Safety of Sedation for Endoscopic Cholangiopancreatography and Ultra-sonography. Gastroenterology, 136, 1568-1576. [Google Scholar] [CrossRef] [PubMed]
[18] Mehta, P.P., Kochhar, G., Albeldawi, M., et al. (2016) Capno-graphic Monitoring in Routine EGD and Colonoscopy with Moderate Sedation: A Prospective, Randomized, Controlled Trial. The American Journal of Gastroenterology, 111, 395-404. [Google Scholar] [CrossRef] [PubMed]
[19] Friedrich-Rust, M., Welte, M., Welte, C., et al. (2014) Capnographic Monitoring of Propofol-Based Sedation during Colonoscopy. Endoscopy, 46, 236-244. [Google Scholar] [CrossRef] [PubMed]
[20] Beitz, A., Riphaus, A., Meining, A., et al. (2012) Capnographic Monitoring Reduces the Incidence of Arterial Oxygen Desaturation and Hypoxemia during Propofol Sedation for Co-lonoscopy: A Randomized, Controlled Study (ColoCap Study). The American Journal of Gastroenterology, 107, 1205-1212. [Google Scholar] [CrossRef] [PubMed]
[21] Barnett, S., Hung, A., Tsao, R., et al. (2016) Capnographic Monitoring of Moderate Sedation during Low-Risk Screening Colonoscopy Does Not Improve Safety or Patient Satis-faction: A Prospective Cohort Study. The American Journal of Gastroenterology, 111, 388-394. [Google Scholar] [CrossRef] [PubMed]
[22] Klare, P., Reiter, J., Meining, A., et al. (2016) Capnographic Monitoring of Midazolam and Propofol Sedation during ERCP: A Randomized Controlled Study (EndoBreath Study). Endoscopy, 48, 42-50. [Google Scholar] [CrossRef] [PubMed]
[23] Bell, G.D., Bown, S., Morden, A., Coady, T. and Logan, R.F.A. (1987) Prevention of Hypoxaemia during Upper-Gastrointestinal Endoscopy by Means of Oxygen via Nasal Cannulae. The Lancet, 329, 1022-1024. [Google Scholar] [CrossRef] 
[24] Shao, L.J., Zou, Y., Liu, F.K., et al. (2020) Comparison of Two Supplemental Oxygen Methods during Gastroscopy with Propofol Mono-Sedation in Patients with a Normal Body Mass Index. World Journal of Gastroenterology, 26, 6867-6879.
[25] Qin, Y., Li, L.Z., Zhang, X.Q., et al. (2017) Su-praglottic Jet Oxygenation and Ventilation Enhances Oxygenation during Upper Gastrointestinal Endoscopy in Patients Sedated with Propofol: A Randomized Multicentre Clinical Trial. British Journal of Anaesthesia, 119, 158-166. [Google Scholar] [CrossRef] [PubMed]
[26] Shao, L.J., Hong, F.X., Liu, F.K., Wen, L. and Xue, F.S. (2021) Prospec-tive, Randomized Comparison of Two Supplemental Oxygen Methods during Gastroscopy with Propofol Mono-Sedation in Obese Patients. World Journal of Clinical Cases, 9, 5479-5489. [Google Scholar] [CrossRef] [PubMed]
[27] Lin, Y., Zhang, X., Li, L., et al. (2019) High-Flow Nasal Cannula Oxygen Therapy and Hypoxia during Gastroscopy with Propofol Sedation: A Randomized Multicenter Clinical Trial. Gastrointestinal Endoscopy, 90, 591-601. [Google Scholar] [CrossRef] [PubMed]
[28] Mclellan, E., Lam, K., Behringer, E., et al. (2020) High-Flow Nasal Oxygen Does Not Increase the Volume of Gastric Secretions during Spontaneous Ventilation. British Journal of Anaes-thesia, 125, E75-E80. [Google Scholar] [CrossRef] [PubMed]
[29] Horiuchi, A. and Graham, D.Y. (2020) High-Flow Nasal Cannula Oxygen Therapy Obscures Severe Respiration Depression, Providing an Illusion of Safety. Gastrointestinal Endoscopy, 91, 720-721. [Google Scholar] [CrossRef] [PubMed]
[30] Chen, D.X., Yang, H., Wu, X.P., et al. (2022) Comparison of a Na-sal Mask and Traditional Nasal Cannula during Intravenous Anesthesia for Gastroscopy Procedures: A Randomized Controlled Trial. Anesthesia and Analgesia, 134, 615-623. [Google Scholar] [CrossRef] 
[31] Rex, D.K., Bhandari, R., Desta, T., et al. (2018) A Phase III Study Evaluating the Efficacy and Safety of Remimazolam (CNS 7056) Compared with Placebo and Midazolam in Pa-tients Undergoing Colonoscopy. Gastrointestinal Endoscopy, 88, 427-437.E6. [Google Scholar] [CrossRef] [PubMed]
[32] Hu, B., Jiang, K., Shi, W., et al. (2022) Effect of Remimazolam Tosilate on Respiratory Depression in Elderly Patients Undergoing Gastroscopy: A Multicentered, Prospective, and Randomized Study. Drug Design, Development and Therapy, 16, 4151-4159. [Google Scholar] [CrossRef] 
[33] Rex, D.K., Bhandari, R., Lorch, D.G., et al. (2021) Safety and Effi-cacy of Remimazolam in High Risk Colonoscopy: A Randomized Trial. Digestive and Liver Disease, 53, 94-101. [Google Scholar] [CrossRef] [PubMed]
[34] Dong, S.A., Guo, Y., Liu, S.S., et al. (2023) A Randomized, Con-trolled Clinical Trial Comparing Remimazolam to Propofol When Combined with Alfentanil for Sedation during ERCP Procedures. Journal of Clinical Anesthesia, 86, Article ID: 111077. [Google Scholar] [CrossRef] [PubMed]
[35] Wang, J., Huang, J., Yang, S., et al. (2019) Pharmacokinetics and Safety of Esketamine in Chinese Patients Undergoing Painless Gastroscopy in Comparison with Ketamine: A Ran-domized, Open-Label Clinical Study. Drug Design, Development and Therapy, 13, 4135-4144. [Google Scholar] [CrossRef] 
[36] Jonkman, K., van Rijnsoever, E., Olofsen, E., et al. (2018) Esketa-mine Counters Opioid-Induced Respiratory Depression. British Journal of Anaesthesia, 120, 1117-1127. [Google Scholar] [CrossRef] [PubMed]
[37] Zhang, K., Bao, Y., Han, X., et al. (2023) Effects of Opioid-Free Propofol or Remimazolam Balanced Anesthesia on Hypoxemia Incidence in Patients with Obesity during Gastrointestinal Endoscopy: A Prospective, Randomized Clinical Trial. Frontiers in Medicine, 10, Article ID: 1124743. [Google Scholar] [CrossRef] [PubMed]
[38] Feng, M., Shi, G., Cui, W., et al. (2022) The Median Effective Concentration of Propofol in Combination with Different Doses of Esketamine during Gastrointestinal Endoscopy in Adults. Frontiers in Pharmacology, 13, Article ID:1034236. [Google Scholar] [CrossRef] [PubMed]
[39] Li, J., Wang, X., Liu, J., et al. (2022) Comparison of Ciprofol (HSK3486) versus Propofol for the Induction of Deep Sedation during Gastroscopy and Colonoscopy Procedures: A Multi-Centre, Non-Inferiority, Randomized, Controlled Phase 3 Clinical Trial. Basic & Clinical Pharmacology & Toxi-cology, 131, 138-148. [Google Scholar] [CrossRef] [PubMed]
[40] Teng, Y., Ou, M., Wang, X., et al. (2021) Efficacy and Safety of Ciprofol for the Sedation/Anesthesia in Patients Undergoing Colonoscopy: Phase IIa and IIb Multi-Center Clinical Trials. Euro-pean Journal of Pharmaceutical Sciences, 164, Article ID: 105904. [Google Scholar] [CrossRef] [PubMed]

为你推荐