经鼻胃镜检查的临床应用评估及对照研究

Evaluation of transnasal esophagogastroduodenoscopy： a controlled trial

目的探讨使用超细电子胃镜经鼻临床应用的安全性和价值。方法将240例行胃镜检查的患者随机分成3组，分别为超细胃镜经鼻检查组（A组，n=82）、超细胃镜经口检查组（B组，n=79）及标准胃镜经口检查组（C组，n=79）。在胃镜检查前及检查过程中通过监护仪记录患者的收缩压、舒张压、脉率、血氧饱和度、心肌耗氧量（以心率动脉收缩压乘积来衡量），并记录内镜插入时间和检查完成时间。胃镜检查结束后所有患者均完成一份问卷调查表。结果在胃镜检查过程中，3组患者的血氧饱和度均有轻微的下降，但下降的比例各组间差异无统计学意义；A组患者收缩压、舒张压、脉率、心肌耗氧量增加的比例均显著低于B组和C组（P〈0，05）。A组患者胃镜插入时不适感及检查时恶心程度的VAS评分最低（P〈0．05）。经鼻胃镜检查较经口胃镜检查耗时更长（P〈0．05），但随着检查例数的增加，经鼻胃镜检查的插入时间会逐渐缩短。结论经鼻胃镜检查，相对于普通内镜检查，患者的痛苦小，耐受性更好，对心血管功能的影响更小，是一种安全、易于掌握的胃镜检查方法，经鼻插入可能是超细胃镜最佳的进镜途径。

Objective To evaluate the safety and efficacy of ultra-thin transnasal esophagogastrodu- odenoscopy（EGD）, Methods The patients（n=240） receiving diagnostic EGD were randomly assigned to 3 groups to undergo ultra-thin trans-nasal EGD（group A, n =82） , ultra-thin trans-oral EGD（group B, n = 79） and conventional trans-oral EGD（group C, n = 79）. The blood pressure, pulse rate, arterial oxygen saturation, myocardial oxygen consumption were monitored and recorded before and during the procedure, as well as the operation time, All patients completed a questionnaire after the procedure, Results No significant difference was found in drop of arterial oxygen saturation between three groups. Increases in pulse rate, blood pressure, rate-pressure product in group A were significantly lower than those in group B and C（P〈0.05）, Patients in group A experienced the lowest VAS scores of discomfort and nausea during the procedure （P〈0.05）. But examination time and insertion time were significantly longer in group A than those in group B and C. With the increase in number of cases, the insertion time for group A decreased gradually. Conclusion Ultra-thin transnasal EGD is well tolerated and has fewer hemodynamic effects. It is safe and may be the optimal route of intubation with ultra-thin scopes.