咽部表面麻醉与清醒镇静及静脉麻醉下行食管静脉曲张结扎术的对比研究

Endoscopic esophageal varices ligation under topical anesthesia, sedation with consciousness or intra-venous anesthesia： a comparison between three anesthetic methods

目的探讨咽部表面麻醉、清醒镇静和静脉麻醉下行食管静脉曲张结扎术（EVL）的有效性、安全性。方法选择同期咽部表面麻醉组（盐酸利多卡因凝胶含服）、清醒镇静组（咪唑安定＋芬太尼）和静脉麻醉组（丙泊酚）患者各50例，观察内镜操作的方便性、患者的耐受性、EVL的效果、操作时间和不良反应。结果咽部表面麻醉组50例均完成EVL治疗，术中40例（80％）出现恶心呕吐反应，9例（18％）有自主拔管行为，10例（20％）食管入口黏膜损伤，4例（8％）术中出现较大量出血。清醒镇静组50例均顺利完成EVL治疗，术中7例（14％）出现轻度恶心反应，无术中出血，5例（10％）出现食管入口黏膜轻度损伤。静脉麻醉组50例均顺利完成EVL治疗，术中患者无任何反应，术中平均血压明显低于术前（P〈0．05），呼吸、心率均比术前减慢，但差异无统计学意义（P〉0．05）。操作时间静脉麻醉组略短，但3组间差异无统计学意义（P〉0．05）。结论清醒镇静和静脉麻醉均比咽部表面麻醉操作方便，患者耐受性好，术中不良反应少，但由于静脉麻醉对呼吸循环有明显影响，故综合比较，清醒镇静下行EVL安全、有效，不良反应少，费用低，可首先采用。

Objective To compare the efficacy and safety of topical anesthesia, conscious sedation and intravenous anesthesia during endoscopic varices ligation （EVL）. Methods Patients underwent EVL were divided into 3 groups to receive different anesthetic methods, namely topical anesthesia, conscious sedation and intravenous anesthesia, with 50 subjects in each group. The changes of vital signs, the tolerance to stimulation of the procedure, the time of operation, the rate of complication were recorded and compared between 3 groups. Results The procedure of EVL were completed in all patients. In topical anesthesia group, 40 （80%） patients bad nausea and vomiting, 9 cases （ 18% ） tried to pull out the endoscopy. The mucosa at the entrance of the esophagus were injured in 10 cases （20%）. Massive bleeding occurred in 4 patients （8%） during operation because of nausea and vomiting. In conscious sedation group, only 7 patients （ 14% ） had mild nausea and vomiting, and no complication of variceal bleeding occurred. The mucosa at the entrance of the esophagus was injured in 5 cases （ 10% ）. In intravenous anesthesia group, no patient had nausea or vomiting. The respiratory rate, heart rate and mean artery pressure decreased during the procedure, but without significant difference （P 〉 0. 05 ）. The operation time in intravenous anesthesia group was shorter than that in other two groups, but without significant difference （ P 〉 0. 05 ）. Conclusion EVL can be completed under 3 different anesthetic methods, while EVL under conscious sedation is more effective and safe.