改良手动胸外按压在预防和治疗上消化道内镜检查中深度镇静患者呼吸抑制中的应用：两项随机对照试验。
Modified Manual Chest Compression for Prevention and Treatment of Respiratory Depression in Patients Under Deep Sedation During Upper Gastrointestinal Endoscopy: Two Randomized Controlled Trials.
机构信息
From the Department of Anaesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
出版信息
Anesth Analg. 2023 Oct 1;137(4):859-869. doi: 10.1213/ANE.0000000000006447. Epub 2023 Apr 3.
BACKGROUND
We aimed to determine the preventive and therapeutic efficacy of modified manual chest compression (MMCC), a novel noninvasive and device-independent method, in reducing oxygen desaturation events in patients undergoing upper gastrointestinal endoscopy under deep sedation.
METHODS
A total of 584 outpatients who underwent deep sedation during upper gastrointestinal endoscopy were enrolled. In the preventive cohort, 440 patients were randomized to the MMCC group (patients received MMCC when their eyelash reflex disappeared, M1 group) or control group (C1 group). In the therapeutic cohort, 144 patients with oxygen desaturation of a Sp o2 < 95% were randomized to MMCC group (patients who subsequently received MMCC, M2 group) or the conventional treatment group (C2 group). The primary outcomes were the incidence of desaturation episodes with an Sp o2 < 95% for the preventive cohort and the time spent below 95% Sp o2 for the therapeutic cohort. Secondary outcomes included the incidence of gastroscopy withdrawal and diaphragmatic pause.
RESULTS
In the preventive cohort, MMCC reduced the incidence of desaturation episodes <95% (14.4% vs 26.1%; RR, 0.549; 95% confidence interval [CI], 0.37-0.815; P = .002), gastroscopy withdrawal (0% vs 2.29%; P = .008), and diaphragmatic pause at 30 seconds after propofol injection (74.5% vs 88.1%; RR, 0.846; 95% CI, 0.772-0.928; P < .001). In the therapeutic cohort, patients who received MMCC had a significantly shorter time spent below 95% Sp o2 (40 [20-69] seconds vs 91 [33-152] seconds, median difference [95% CI], -39 [-57 to -16] seconds, P < .001), a lower incidence of gastroscopy withdrawal (0% vs 10.4%, P = .018), and more enhanced diaphragmatic movement at 30 seconds after Sp o2 <95% (1.11 [0.93-1.4] cm vs 1.03 [0.7-1.24] cm; median difference [95% confidence interval], 0.16 [0.02-0.32] cm; P = .015).
CONCLUSIONS
MMCC may exert preventive and therapeutic effects against oxygen desaturation events during upper gastrointestinal endoscopy.
背景
我们旨在确定改良手动胸外按压（MMCC）在减少深度镇静下上消化道内镜检查中患者的氧饱和度降低事件的预防和治疗效果。
方法
共纳入 584 名接受深度镇静下上消化道内镜检查的门诊患者。在预防队列中，440 名患者被随机分配至 MMCC 组（当患者的睫毛反射消失时，即 M1 组，给予 MMCC）或对照组（C1 组）。在治疗队列中，144 名氧饱和度为 Sp o2 < 95%的患者随机分为 MMCC 组（患者随后接受 MMCC，即 M2 组）或常规治疗组（C2 组）。主要结局为预防队列中 Sp o2 < 95%的患者出现低氧饱和度发作的发生率和治疗队列中 Sp o2 < 95%的时间。次要结局包括胃镜退出和膈肌暂停的发生率。
结果
预防队列中，MMCC 降低了 Sp o2 < 95%的患者低氧饱和度发作的发生率（14.4%比 26.1%；RR，0.549；95%CI，0.37-0.815；P =.002）、胃镜退出（0%比 2.29%；P =.008）和丙泊酚注射后 30 秒的膈肌暂停（74.5%比 88.1%；RR，0.846；95%CI，0.772-0.928；P <.001）。治疗队列中，接受 MMCC 的患者 Sp o2 < 95%的时间明显缩短（40 [20-69] 秒比 91 [33-152] 秒，中位数差值[95%CI]，-39 [-57 至-16] 秒，P <.001）、胃镜退出率较低（0%比 10.4%，P =.018）、Sp o2 < 95%后 30 秒膈肌运动增强（1.11 [0.93-1.4]cm 比 1.03 [0.7-1.24]cm；中位数差值[95%CI]，0.16 [0.02-0.32]cm；P =.015）。
结论
MMCC 可能对上消化道内镜检查期间的氧饱和度降低事件具有预防和治疗作用。
Zotero 插件