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中华胃肠内镜电子杂志 ›› 2026, Vol. 13 ›› Issue (03) : 185 -194. doi: 10.3877/cma.j.issn.2095-7157.2026.03.007

论著

老年患者镇静/麻醉消化内镜低氧血症危险因素的Meta分析
张艳燕1,2, 陈典洁3, 郝婧4, 周婷1, 石乐康1, 邹晨曦1, 马慧5,†()   
  1. 1100853 北京,解放军总医院第一医学中心呼吸与危重症医学科
    2100853 北京,解放军总医院解放军医学院
    3100039 北京,解放军总医院感染病医学部
    4100853 北京,解放军总医院消化内科医学部
    5100853 北京,解放军总医院第一医学中心
  • 收稿日期:2026-08-01 出版日期:2026-08-15
  • 通信作者: 马慧
  • 基金资助:
    首都卫生发展科研专项项目(2024-1G-5011)

Risk factors for hypoxemia during gastrointestinal endoscopy under sedation or anesthesia in older patients: A Meta-analysis

Yanyan Zhang1,2, Dianjie Chen3, Jing Hao4, Ting Zhou1, Lekang Shi1, Chenxi Zou1, Hui Ma5,†()   

  1. 1Department of Pulmonary and Critical Care Medicine, First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
    2Chinese PLA Medical School, Beijing 100853, China
    3Senior Department of Infectious Diseases, Chinese PLA General Hospital, Beijing 100039, China
    4Department of Gastroenterology, Chinese PLA General Hospital, Beijing 100853, China
    5The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
  • Received:2026-08-01 Published:2026-08-15
  • Corresponding author: Hui Ma
引用本文:

张艳燕, 陈典洁, 郝婧, 周婷, 石乐康, 邹晨曦, 马慧. 老年患者镇静/麻醉消化内镜低氧血症危险因素的Meta分析[J/OL]. 中华胃肠内镜电子杂志, 2026, 13(03): 185-194.

Yanyan Zhang, Dianjie Chen, Jing Hao, Ting Zhou, Lekang Shi, Chenxi Zou, Hui Ma. Risk factors for hypoxemia during gastrointestinal endoscopy under sedation or anesthesia in older patients: A Meta-analysis[J/OL]. Chinese Journal of Gastrointestinal Endoscopy(Electronic Edition), 2026, 13(03): 185-194.

目的

本研究拟系统梳理老年患者在镇静/麻醉下接受消化内镜诊疗时发生低氧血症及相关不良事件的危险因素,为术前风险识别和围术期预防提供参考。

方法

依据PRISMA 2020开展系统评价。检索PubMed、Web of Science、Cochrane Library、Embase、CINAHL及主要中文数据库,时间范围为各数据库建库至2026年7月23日。纳入能够提取危险因素数据的观察性研究,采用NOS评价研究质量,并使用RevMan 5.3完成Meta分析。

结果

共纳入10项研究,按表1统计总样本量为8 284例,NOS评分为7~9分。合并分析中,高龄(OR=2.99)、较高BMI(OR=3.54)、高血压(OR=1.73)、吸烟史(OR=2.58)及饮酒史(OR=1.41)均与结局风险增加有关;肺部疾病/COPD(RR=2.41)、打鼾史(OR=3.53)和较高ASA分级(OR=3.11)同样表现出统计学关联。性别(OR=1.17,P=0.07)及糖尿病(随机效应OR=1.30,P=0.16)与结局的关联未达到统计学意义。

结论

现有证据表明,高龄、较高BMI、打鼾史、高血压、吸烟史、饮酒史、肺部疾病/COPD以及较高ASA分级可能增加老年患者镇静/麻醉消化内镜期间发生低氧血症或相关不良事件的风险。临床评估时可重点关注上述人群,并结合患者情况制定氧合与气道管理方案。考虑到部分研究使用复合不良事件作为结局,且若干因素存在较高异质性,上述结论仍有待更多高质量前瞻性研究进一步验证。

Objective

To systematically summarize the risk factors for hypoxemia and related adverse events in older patients undergoing gastrointestinal endoscopy under sedation or anesthesia, and to provide evidence for preprocedural risk stratification and perioperative prevention.

Methods

A systematic review was conducted in accordance with PRISMA 2020. PubMed, Web of Science, Cochrane Library, Embase, CINAHL, and major Chinese databases were searched from inception to August 23, 2026. Observational studies reporting extractable data on risk factors were included. Study quality was assessed using the Newcastle-Ottawa Scale (NOS), and meta-analysis was performed with RevMan 5.3.

Results

Ten studies involving a total of 8, 284 participants were included, with NOS scores ranging from 7 to 9. Pooled analyses showed that advanced age (OR=2.99), higher body mass index (BMI; OR=3.54), hypertension (OR=1.73), a history of smoking (OR=2.58), and a history of alcohol consumption (OR=1.41) were associated with an increased risk of the outcome. Pulmonary disease/chronic obstructive pulmonary disease (COPD; RR=2.41), a history of snoring (OR=3.53), and higher American Society of Anesthesiologists (ASA) physical status (OR=3.11) were also significantly associated with increased risk. Sex (OR=1.17, P=0.07) and diabetes mellitus (random-effects OR=1.30, P=0.16) were not significantly associated with the outcome.

Conclusion

Current evidence suggests that advanced age, higher BMI, a history of snoring, hypertension, smoking, alcohol consumption, pulmonary disease/COPD, and higher ASA physical status may increase the risk of hypoxemia or related adverse events during gastrointestinal endoscopy under sedation or anesthesia in older patients. These factors should be considered in preprocedural assessment and individualized oxygenation and airway-management strategies. Because some included studies used composite adverse-event outcomes and several risk factors showed substantial heterogeneity, these findings require further confirmation in high-quality prospective studies.

图1 文献筛选流程图
表1 纳入研究的基本特征[例(%)]
表2 纳入研究质量评价(NOS评分)
图2 年龄与低氧血症/相关不良事件的Meta分析
图3 性别与低氧血症/相关不良事件的Meta分析
图4 BMI与低氧血症/相关不良事件的Meta分析
图5 打鼾史与低氧血症/相关不良事件的Meta分析
图6 高血压与低氧血症/相关不良事件的Meta分析
图7 吸烟史与低氧血症/相关不良事件的Meta分析
图8 饮酒史与低氧血症/相关不良事件的Meta分析
图9 肺部疾病/COPD与低氧血症/相关不良事件的Meta分析
图10 ASA分级的Meta分析及敏感性分析
图11 糖尿病的Meta分析及敏感性分析
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