目的 探讨内镜面罩对肥胖患者无痛胃镜检查应用的有效性和安全性。方法 选择体重指数(BMI)大于28 kg/m²的行无痛胃镜检查患者100例 , 随机分为两组, 每组50例, 一组采用内镜面罩给氧(T组), 另一组采用鼻导管吸氧(C组), 氧流量均设置为3～5 L/min。两组均静脉注射芬太尼(0.05 mg)、咪达唑仑(1 mg)、丙泊酚(1~2 mg/kg), 至患者睫毛反射消失开始检查, 检查中若有轻微体动及时追加丙泊酚用量。记录麻醉前(T₁)、麻醉后2 min(T₂)和操作结束时(T₃)患者的收缩压(SBP)、舒张压(DBP)、心率(HR)和脉搏氧饱和度(SpO₂), 以及胃镜检查时间和丙泊酚用药总量。结果 (1)两组T₂及T₃时SBP、DBP和HR与T₁相比均有所下降, 差异有统计学意义(P<0.05)。(2)在T₂时, C组受检者SpO₂下降明显, 检查中有6例 (12％)发生SpO₂＜90％, 与T₁比较, 差异有统计学意义(P<0.05);而T组受检者与T₁相比明显增加, 差异有统计学意义(P<0.05), T组SpO₂(99.26%±0.90%)明显高于 C组(92.68%±2.30%), 差异有统计学意义(P<0.05);T₃时, T组SpO₂ (99.58%±0.61%)也明显高于C组(96.24%±0.98%), 差异有统计学意义(P<0.05)。(3)两组患者胃镜操作时间及丙泊酚的用量相比, 差异无统计学意义。结论 肥胖患者无痛胃镜检查中使用内镜面罩给氧优于鼻导管给氧, 使无痛胃镜检查更为安全。

Objective To investigate the efficacy and safety of endoscopic mask for painless gastroscopy examination in obese patients. Methods 100 patients with body mass index (BMI) ＞28 kg/m² who received painless gastroscopy examination were randomized into two groups. Patients in group T inhaled oxygen with endoscopic mask(n=50), and patients in group C inhaled oxygen with nasal cannula(n=50).In the two groups, oxygen flow rates were set at 3-5 L/min.All patients were intravenously injected fentanyl 0.05 mg, midazolam 1 mg, and followed by propofol 1-2 mg/kg. Physicians began to examine when patients lost consciousness. During the procedure, propofol was given in time to keep a level of deep sedation if the patients had small body movement. SBP, DBP, HR, SpO₂ of T1 (before anesthesia), T₂ (two minutes after anesthesia), T₃ (at the end of examination) were recorded. In addition, the examination time, total dose of propofol administration in the two groups were recorded. Results (1) Compared with T1, the SBP、DBP and HR in the two groups at T₁, T₂ decreased distinctly, the differences were statistically significant (P<0.05). (2) At T₂, the SpO₂ in group C decreased significantly, there were 6 patients(12％) with SPO₂<90％, compared with T₁, the difference was statistically significant(P<0.05); the SpO₂ in group T increased, which was statistically significant. At T₂, the SpO₂ (99.26%±0.90%) in group T significantly higher than that in group C (92.68%±2.30%), the difference was statistically significant (P<0.05). At T₃, there was also significant difference between the two groups [(99.58%±0.61%) vs (96.24%±0.98%)].(3) Compared with the examination time and total dose of propofol of the two groups, the differences were not statistically significant. Conclusions The application of oxygen inhalation with endoscopic mask appears to be more safer than that of oxygen inhalation with nasal cannula for painless gastroscopy examination in obese patients.