| Background Laryngopharyngeal reflux refers to the abnormal reflux of gastric acid,pepsin,bile and other gastric contents to the oropharynx.The typical symptoms are acid regurgitation and heartburn,throat and lung symptoms,such as cough and hoarseness.Some studies have shown that the incidence of laryngopharyngeal reflux is about 2.5% ~ 25% according to different detection areas and standards.However,in painless gastroscopy,due to the particularity of the population and the influence of propofol sedation,body position change and increased intra-abdominal pressure caused by intragastric inflation,it can be predicted that the incidence of laryngopharyngeal reflux will increase.The gastric contents that reflux to the throat can be inhaled into the airway by mistake,causing a series of clinical manifestations of SRAEs,such as cough,decrease of blood oxygen saturation and so on.However,there is no report on the incidence of laryngopharyngeal reflux and its related risk factors in patients undergoing painless gastroscopy.Objective Objective to investigate the incidence and risk factors of laryngopharyngeal reflux in patients undergoing painless gastroscopy,which is very important to prevent or reduce the occurrence of laryngopharyngeal reflux in painless gastroscopy,improve the quality of painless gastroscopy,and improve the satisfaction of endoscopists and patients.Methods Patients undergoing gastroscopy under intravenous anesthesia in digestive endoscopy of Northern Jiangsu People’s Hospital from June 2020 to September 2020 were enrolled as the research objects,and relevant data were collected.The samples of supraglottic secretion before and after gastroscopy were collected,and the content of human pepsin was determined by ELISA.The patients with positive pepsin test of supraglottic secretion before gastroscopy were excluded,a total of 296 patients were included in Part One of this researh.According to the change of pepsin content before and after gastroscopy,they were divided into reflux group(R group,positive pepsin test of supraglottic secretion after gastroscopy)and non reflux group(N group,negative pepsin test of supraglottic secretion after gastroscopy).SPSS 26.0 software was used to analyze the gender,age,BMI,smoking history,drinking history,history of hypertension,diabetes history,ASA classification,Mallampati airway classification,lidocaine mucilage use,fasting duration,history of acid regurgitation and belching,history of gastroesophageal surgery,duration of gastroscopy operation,total dosage of propofol,standard dosage of propofol and other related factors were statistically analyzed by multivariate logistic regression analysis.Results 1.The incidence of laryngopharyngeal reflux was about 31.1%;2.Statistical analysis of 16 related factors showed that: age,body mass index,smoking history ratio,drinking history ratio,acid reflux and belching history ratio,operation time,standard dosage of propofol and other 7 factors in different groups were statistically significant(P < 0.05);there were no significant differences in gender,history of hypertension,history of diabetes,history of gastroesophageal surgery,use of lidocaine mucilage,Mallampati airway grade,ASA grade,fasting duration and total dosage of propofol among different groups(P > 0.05).Multivariate logistic regression analysis showed that age,history of acid regurgitation and belching,duration of operation and standardized dosage of propofol were independent risk factors of laryngopharyngeal reflux in painless gastroscopy(P < 0.05).Conclusion Age,history of acid regurgitation and belching,duration of operation and standard dosage of propofol are independent risk factors of laryngopharyngeal reflux in patients undergoing painless gastroscopy.Background Sedation related adverse events(SRAEs)refer to a series of adverse events related to the use of narcotic drugs that need to be dealt with after patients receive anesthesia / sedation.The main clinical manifestations of SRAEs were decreased blood pressure,decreased oxygen saturation,bradycardia,arrhythmia,reflux aspiration and other cardiopulmonary complications.With the development of painless gastroscopy,the complexity of gastroscopy under anesthesia / sedation is increasing,and the proportion of deep sedation level is gradually increasing,which leads to the inhibition of lower esophageal sphincter and laryngopharyngeal protective reflex.Gastric contents that reflux to the throat can be inhaled into the airway by mistake,causing a series of clinical manifestations of SRAEs,such as cough and decrease of blood oxygen saturation,which often require the intervention of clinical anesthesiologists,or even the termination of gastroscopy.Objective To evaluate the effect of laryngopharyngeal reflux on sedation related adverse events in patients undergoing painless gastroscopy,so as to provide clinical reference for the prevention and treatment of sedation related adverse events in painless gastroscopy.Methods Patients undergoing gastroscopy under intravenous anesthesia in digestive endoscopy of Northern Jiangsu People’s Hospital from June 2020 to September 2020 were enrolled as the research objects,and relevant data were collected.The samples of supraglottic secretion before and after gastroscopy were collected,and the content of human pepsin was determined by ELISA.The patients with positive pepsin test of supraglottic secretion before gastroscopy were excluded.According to the change of pepsin content before and after gastroscopy,they were divided into reflux group(R group,positive pepsin test of supraglottic secretion after gastroscopy)and non reflux group(N group,negative pepsin test of supraglottic secretion after gastroscopy).From the Part One,we know that age is a risk factor of laryngopharyngeal reflux in patients undergoing painless gastroscopy,but it is a non research factor in the Part Two of this research,and Propensity Score(PS)was used to eliminate 7 subjects,so that the two groups of patients with age factors to achieve a balance,and ultimately a total of 289 patients were included in the Part Two of this research,to ensure that the reflux group and non reflux group of patients with general data difference was not statistically significant.The occurrence of body movement,cough,oxygen saturation decrease,hypotension and bradycardia during gastroscopy were recorded.Telephone follow-up on the first day,the third day and the seventh day after gastroscopy showed the occurrence of sore throat,hoarseness,nausea and vomiting,cough and expectoration,fever and runny nose,and the use of antibiotics.Chi square test was used for comparison between groups.Results There was no significant difference in the incidence of body movement,hypotension and bradycardia in painless gastroscopy between the two groups(P > 0.05).Compared with Group N,the incidence of cough and oxygen saturation decrease in painless gastroscopy in Group R was higher(P < 0.05).Compared with Group N,the incidence of sore throat,hoarseness,cough and expectoration increased in Group R on the first day after gastroscopy(P < 0.05);compared with Group N,the incidence of cough and expectoration,fever and runny nose increased in Group R on the third day after gastroscopy(P < 0.05);there was no significant difference in the incidence of sares between the two groups on the seventh day after gastroscopy(P > 0.05)。Conclusion 1.Laryngopharyngeal reflux can increase the incidence of SRAEs such as cough and oxygen saturation decrease;2.Laryngopharyngeal reflux can increase the incidence of SRAEs such as cough,expectoration,fever and runny nose on the third day after examination;3.Laryngopharyngeal reflux had no significant effect on the incidence of SRAEs on the 7th day after gastroscopy,and all adverse events disappeared. |
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