Alcaín G, Guillén P, Escolar A, Moreno M, Martín L
Servicio de Aparato Digestivo, Hospital Universitario Puerta del Mar, Cádiz, Spain.
Gastrointest Endosc. 1998 Aug;48(2):143-7. doi: 10.1016/s0016-5107(98)70155-5.
Hypoxemia can occur during upper gastrointestinal endoscopy with or without pharmacologic sedation. We investigated possible predictive factors of severe oxygen desaturation (SaO2 < 90%) in nonsedated patients undergoing endoscopy.
A total of 481 patients who underwent upper gastrointestinal endoscopy without sedation were monitored with continuous pulse oximetry. Multivariate logistic regression analysis was used to identify factors related to the patient, the examination, and the monitoring data that would predict severe desaturation.
Mild desaturation (SaO2 between 90% and 94%) was found in 23.7% of the patients, and severe desaturation (SaO2 < 90%) was found in 6.4%. The variables found to predict severe desaturation were basal SaO2 < 95% (odds ratio 67.7), respiratory disease (odds ratio 30.5), more than one attempt needed for intubation (odds ratio 39.4), emergency procedure (odds ratio 14.9), and American Society of Anesthesiologists score of III or IV (odds ratio 3.9).
The predictive variables analyzed in this study can be used to identify patients who are at increased risk for desaturation. Such patients require very close monitoring (pulse oximetry at a minimum). Endoscopists and assistants should be especially alert to the possibility of respiratory depression in these patients.
在进行上消化道内镜检查时，无论是否使用药物镇静，都可能发生低氧血症。我们调查了未使用镇静剂的内镜检查患者发生严重氧饱和度下降（动脉血氧饱和度<90%）的可能预测因素。
对481例未使用镇静剂进行上消化道内镜检查的患者进行连续脉搏血氧饱和度监测。采用多因素逻辑回归分析来确定与患者、检查及监测数据相关的可预测严重氧饱和度下降的因素。
23.7%的患者出现轻度氧饱和度下降（动脉血氧饱和度在90%至94%之间），6.4%的患者出现严重氧饱和度下降（动脉血氧饱和度<90%）。发现可预测严重氧饱和度下降的变量有：基础动脉血氧饱和度<95%（比值比67.7）、呼吸系统疾病（比值比30.5）、插管需要多次尝试（比值比39.4）、急诊手术（比值比14.9）以及美国麻醉医师协会评分III或IV级（比值比3.9）。
本研究分析的预测变量可用于识别氧饱和度下降风险增加的患者。这类患者需要非常密切的监测（至少进行脉搏血氧饱和度监测）。内镜医师和助手应特别警惕这些患者发生呼吸抑制的可能性。
