经鼻内镜检查患者耐受性的前瞻性随机对照研究

The prospective randomized controlled study about tolerability of transnasal esophagogastroduodenoscopy

目的探讨经鼻内镜检查患者的耐受性及其临床应用价值。方法120例接受上消化道内镜检垒的患者按就诊顺序随机分入经鼻内镜检查组（经鼻组）或经口内镜检查组（经口组），每组60例。观察并记录术中患者呕吐反射次数，心率、血压波动情况，以及经鼻检查者有无鼻腔出血。术后对患者进行现场问卷调查。结果除经鼻组有2例因鼻甲肥大致鼻腔狭窄转经口检查外，两组其他患者均完成内镜检查。平均榆杏时间：经鼻组（362．9±112．6）s，经口组（412．1±162．2）s，差异有统计学意义（t=2．12，P〈0．05）；检查过程中平均呕吐反射次数：经鼻组（3．6±1．5）次，经口组（8．4±3．4）次，差异有统计学意义（f=2．26，P〈0．05）；经鼻组榆杏过程中血压、脉搏无明显波动，经口组血压、脉搏波动明显，筹异有统计学意义（t值分别为2．36和2．58，P〈0．05）。问卷调查发现，经鼻组恶心、呕吐较经口组明显减轻，仅2例（3．3％）诉鼻腔轻度疼痛，其余56例（96．6％，56／58）诉鼻腔无疼痛感觉。榆查结束后经鼻组所有患者表示愿意再次接受经鼻内镜检查，而经口组有30例（50．0％）明确表示不愿意再次行经口内镜检杏。结论经鼻因镜检查较经口内镜检查患者的呕叶反应更少，舒适性更高，患者耐受性更好，是一种安全、舒适的检查方法。

Objective To study the tolerability and clinical value of transnasal esophagogastroduodenoscopy. Methods A prospective randmnized controlled study has been designed. A total of 120 patients have been enrolled into the study, who were randomly divided into the transnasal group and the oral group （n = 60 cases in each group）. Vomiting frequency, pulse rate, SBP and nasal hemorrhage were recorded delively before the examination,and at every 2-rain till the end of the examination. Results The examination time were （362.9±112.6）s in transnasal group, and （412.1 ± 162.2）s in oral group （t =2.12,P〈 0. 05）. The questionnaire survey showed that patients in transnasal group had less vomitting and cough than in oral group （ t = 2. 26 ,P 〈 0. 05 ）. Fluctuation of SBP and pulse rate in patients undergoing transnasal gastruscope was less than in those undergoing oral procedures （t =2. 36 and 2.58 ,P 〈0. 05）. According to the surey, the patients in transnasal group got less feelings of nausea or vomiting than in oral group. Only 2 （3.3%） patients felt mild pain in nasal cavity. The other 56 （96. 6% ,56/58） felt no pain at all. All the patients would like to accept the transnasal esophagogastroduodenoscopy next time, while half of the patients in oral group disliked peroral gastroscopy. Conclusion The study demonstrates much more tolerability in patients undergoing transnasal esophagogastroduodenoseopy than peroral.