CAJ | 학술논문

目的评价无痛消化内镜麻醉管理模式的安全性和可行性.方法对采用麻醉医生指导的护士约诊、术中协助、术后苏醒观察的麻醉管理模式下施行的17100例无痛消化内镜诊疗患者的病例资料进行回顾性分析,统计严重不良反应及并发症发生情况,并于所有病例中按病历编号随机抽取800例,胃镜组、肠镜组、EUS组、ERCP组患者各200例,统计各组内镜诊疗时间、入睡时间、苏醒时间、离科时间以及并发症发生情况.结果 17 100例中发生严重不良反应者10例(0.058％),包括呼吸暂停3例,缩颌、舌后坠致上呼吸道梗阻1例,进镜时喉痉挛5例,经口肠梗阻导管置入术中反流误吸1例；无一例与麻醉及内镜诊疗相关的死亡病例.800例抽样结果显示,术中平均动脉压升高或降低超过基础值30％、心率加快或减慢超过基础值30％、血氧饱和度＜95％的发生率分别在6.0％～25.0％、3.0％～8.5％、≤2.0％；术中遗忘率在99％～100％,睡眠质量好发生率在98.0％～100.0％；术中呛咳发生率在0.5％～4.5％,体动发生率在5.5％～11.5％,肌阵挛发生率在1.5％～3.5％；术后恶心呕吐、兴奋、躁动、眩晕发生率均不高于4％.结论采用麻醉医生指导的护士约诊、术中协助、术后苏醒观察的麻醉管理模式是安全和可行的,有利于提高麻醉效能,减少并发症.
목적 평개무통소화내경마취관리모식적안전성화가행성.방법 대채용마취의생지도적호사약진、술중협조、술후소성관찰적마취관리모식하시행적17100례무통소화내경진료환자적병례자료진행회고성분석,통계엄중불량반응급병발증발생정황,병우소유병례중안병력편호수궤추취800례,위경조、장경조、EUS조、ERCP조환자각200례,통계각조내경진료시간、입수시간、소성시간、리과시간이급병발증발생정황.결과 17 100례중발생엄중불량반응자10례(0.058％),포괄호흡잠정3례,축합、설후추치상호흡도경조1례,진경시후경련5례,경구장경조도관치입술중반류오흡1례；무일례여마취급내경진료상관적사망병례.800례추양결과현시,술중평균동맥압승고혹강저초과기출치30％、심솔가쾌혹감만초과기출치30％、혈양포화도＜95％적발생솔분별재6.0％～25.0％、3.0％～8.5％、≤2.0％；술중유망솔재99％～100％,수면질량호발생솔재98.0％～100.0％；술중창해발생솔재0.5％～4.5％,체동발생솔재5.5％～11.5％,기진련발생솔재1.5％～3.5％；술후악심구토、흥강、조동、현훈발생솔균불고우4％.결론 채용마취의생지도적호사약진、술중협조、술후소성관찰적마취관리모식시안전화가행적,유리우제고마취효능,감소병발증.
Objective To evaluate the safety and feasibility of the standardized management model of anesthesia for painless digestive endoscopy.Methods Data of 17 100 patients who underwent painless endoscopy were reviewed for severe adverse reaction and complications.The model included anaesthetist-directed appointment,nurse assistance during operation,and postoperative nurse observation.Eight hundred cases (200 of gastric endoscopy,intestinal endoscopy,EUS and ERCP respectively) were randomly selected and analyzed for times of endoscopic diagnosis,anesthesia,wakening and discharge,and complications.Results Of the 17 100 cases,severe complications occurred in 10 (0.058％ ),including 3 apnea,one respiratory obstruction due to opisthognathism and glossoptosis,five larygneal spasm and 1 reflux inspiration.There was no anesthesia or endoscopy related death.Study of 800 cases showed intraoperative MAP,HR increase or decrease over 30％ of the baseline,the incidence of SpO2 ＜ 95％ were 6.0％～ 25.0％,3.0％～8.5％,≤2.0％,respectively.The rate of lethe,good quality of sleep were 99％～ 100％ and 98.0％～100.0％,respectively.The rates of cough,body movement and myoclonic were 0.5％～4.5％,5.5％～11.5％,and 1.5％～ 3.5％,respectively.Rates of nausea and vomiting,excitement,restlessness and dizziness were lower than 4％.Conclusion The standardized management model,feasible,safe and effective,is able to facilitate anesthetic efficacy and reduce complications.