Dhariwal A, Plevris J N, Lo N T, Finlayson N D, Heading R C, Hayes P C
University Department of Medicine, Royal Infirmary, Edinburgh, United Kingdom.
Gastrointest Endosc. 1992 Nov-Dec;38(6):684-8. doi: 10.1016/s0016-5107(92)70564-1.
Although upper gastrointestinal endoscopy is generally a safe procedure, it is known to be associated with arterial oxygen desaturation. We studied 82 patients undergoing diagnostic upper gastrointestinal endoscopy following a standard premedication consisting of xylocaine throat spray and intravenous midazolam. The mean duration of endoscopy was 8.5 +/- 0.42 min and the mean dose of midazolam was 6.3 +/- 0.15 mg. The baseline SaO2 was 94.91 +/- 0.27% and it decreased after pre-medication to 92.84 +/- 0.40% (p < 0.001) and after intubation to 91.21 +/- 0.40% (p < 0.001). A fall greater than 4% saturation occurred for 15.68% of the total endoscopy time. SaO2 < 90% was seen for 16.7% and SaO2 < 85% occurred for 2.33% total endoscopy time. In patients > 65 years old, hemoglobin < 10 g/dl, or body mass index > 28, the baseline saturation was significantly lower and a reduced SaO2 was seen throughout the procedure. We identify old age, anemia, and obesity as independent risk factors for arterial oxygen desaturation. We recommend continuous monitoring before sedation, and giving supplemental oxygen to patients with these risk factors from the outset of upper gastrointestinal endoscopy.
尽管上消化道内镜检查通常是一种安全的操作，但已知它与动脉血氧饱和度降低有关。我们研究了82例接受诊断性上消化道内镜检查的患者，这些患者在接受由利多卡因咽喉喷雾和静脉注射咪达唑仑组成的标准术前用药后进行检查。内镜检查的平均持续时间为8.5±0.42分钟，咪达唑仑的平均剂量为6.3±0.15毫克。基线血氧饱和度（SaO2）为94.91±0.27%，术前用药后降至92.84±0.40%（p<0.001），插管后降至91.21±0.40%（p<0.001）。在整个内镜检查时间中，饱和度下降超过4%的情况占15.68%。血氧饱和度<90%的情况在整个内镜检查时间中占16.7%，血氧饱和度<85%的情况占2.33%。在年龄>65岁、血红蛋白<10 g/dl或体重指数>28的患者中，基线饱和度显著较低，并且在整个检查过程中血氧饱和度均降低。我们确定高龄、贫血和肥胖是动脉血氧饱和度降低的独立危险因素。我们建议在镇静前进行持续监测，并从开始上消化道内镜检查起就对有这些危险因素的患者给予补充氧气。
