麻醉胃镜下贲门失弛缓症气囊扩张治疗的临床研究

Study on balloon dilation of achalasia under painless gastroscopy

目的 研究麻醉胃镜下贲门失弛缓症气囊扩张治疗的效果及患者对治疗的反应。方法 贲门失弛缓症患者15例,在确诊后应用咪唑安定和丙泊酚行麻醉胃镜下气囊扩张治疗。观察患者扩张治疗中的反应,记录操作时间、清醒时间及检查前中后心率、血压及血氧饱和度变化,记录扩张治疗前、治疗后3 d临床症状积分及测压指标。结果 麻醉时所有患者均入睡,无术中知晓,一般于术后1-5 min内唤醒。患者扩张治疗直至术后苏醒需17-27 min,平均23.2 min。检查中及检查后无心率、血压及血氧饱和度的改变。扩张治疗后22患者的临床症状与治疗前相比明显改善(P<0.01)。结论 在扩张治疗中引入麻醉胃镜技术,减轻了患者痛苦、增加了治疗的依从性。麻醉中保持呼吸道通畅,严密监测心率、血压及血氧饱和度是治疗安全、可行的保证。

Objective To study on the efficacy and safety of treating achalasia by gastroscopic balloon dilation under anesthesia. Methods Fifteen patients with achalasia were given intravenous propofol and midazolam before dilation. Patient's feeling or distress and operative duration were recorded. The changes of blood pressure (BP) , heart rate ( HR) and blood oxygen saturation ( SpO2 ) were also recorded and analyzed. Results Patients did not complain of any discomfort or pain during gastroscopy. The time of recovery from anesthesia was 17 -27(23. 2) minutes. There were significant changes in clinical scores before and after dilation ( P <0. 01 ) , but no significant changes in BP, HR, SpO2 ,etc. Conclusion Gastroscopy can be performed effectively and safely in balloon dilatation of achalasia after intravenous use of propofol and midazolam.