关键词: 环杓关节活动, 睫毛反射, 无痛胃镜, 进镜时机

Abstract: Objective To evaluate the efficacy of using the disappearance of cricoarytenoid joint mobility as an indicator for guiding the timing of gastroscope insertion during sedated gastroscopy.Methods A total of 60 patients undergoing sedated gastroscopy at Wuhan Fourth Hospital were enrolled,including both genders,aged 18-79 years,with a body mass index(BMI)of 18-30 kg/m²,and American Society of Anesthesiologists(ASA)physical statusⅠ-Ⅲ.Patients were randomly divided into an observation group(n=30)and a control group(n=30)using random number table method.Anesthesia was conducted in both groups with intravenous sufentanil 0.1 μg/kg,followed by intravenous propofol 1-2 mg/kg 2 min later.Insertion indicators were assessed 2 min after the initial loading dose in both groups.In the observation group,gastroscope insertion was performed after disappearance of cricoarytenoid joint mobility.Whereas in the control group,insertion was performed after disappearance of eyelash reflex.Additional propofol(0.5 mg/kg)would be administered if intubating conditions were suboptimal.Intraoperative maintenance was achieved with a propofol infusion at 4-10 mg/(kg·h).The number of patients in optimal intubating conditions was recorded in both groups.Incidences of coughing,body movement,groaning,respiratory depression,and rescue anesthesia during insertion were documented.Intraoperative anesthetic consumption,anesthesia duration,and endoscopic procedure time were recorded.Respiratory depression during the procedure and heart rate(HR)and blood pressure(BP)at four time points were recorded:before anesthesia(T0),after the initial propofol loading dose(T1),at endoscope insertion(T2),and 5 min after insertion(T3).Postoperative adverse reactions were also documented.Results Two minutes after the initial loading dose,24 patients in the observation group exhibited disappearance of cricoarytenoid joint motion,whereas eyelash reflex disappeared in all patients in the control group,with a statistically significant difference between the two groups(P<0.05).During the insertion phase,the control group showed 6 cases of coughing/movement,3 of hiccups,2 of groaning,and 2 of decreased SpO₂;6 patients required a supplemental dose of propofol.No adverse events occurred in the observation group.Statistically significant differences were observed between the two groups in the incidence of coughing,body movement,and the number of patients requiring supplemental anesthesia during the insertion phase(all P<0.05).No significant difference was found between the two groups in anesthetic consumption,anesthesia duration,or procedure time(all P>0.05).HR and BP remained stable in the observation group,whereas the control group showed sinus tachycardia and elevated BP at T2(all P<0.05).No postoperative agitation,delirium,or delayed emergence was observed in either group.Conclusion Disappearance of cricoarytenoid joint mobility is a reliable guiding indicator for gastroscope insertion timing during sedated gastroscopy,and is associated with fewer insertion-related adverse events,including coughing,body movements,and hemodynamic fluctuations.

Key words: cricoarytenoid joint mobility, eyelash reflex, sedated gastroscopy, insertion timing