老年冠心病患者经鼻胃镜检查的安全性分析

Safety of transnasal endoscopy for the elderly with coronary heart disease

目的探讨老年冠心病患者经鼻胃镜检查的安全性。方法选择2012年1月至2012年12月在北京老年医院接受胃镜检查的65岁以上老年患者100例，分为经鼻胃镜及普通胃镜组（各50例），每组再分为冠心病及非冠心病（各25例），比较各组胃镜检查中心率、血压、血氧饱和度、心肌耗氧量及心电图变化。结果普通胃镜检查中，冠心病患者心率、血压、心肌耗氧量增加较非冠心病患者明显（P＜0.05），血氧饱和度下降值较非冠心病患者高（P＜0.05），冠心病患者心律失常及ST段下移发生率较非冠心病患者高（P＜0.05）；冠心病患者经鼻胃镜检查中，心率、血压、心肌耗氧量增加值较普通胃镜明显低（P＜0.05），血氧饱和度下降值低（P＜0.05），心律失常及ST段下降发生率低（P＜0.05）。结论老年冠心病患者经鼻胃镜检查耐受性好，对心血管影响小，安全性高。

Objective To determine the safety of transnasal endoscopy for the elderly with coronary heart diseases （CHD）. Methods A prospective study was carried out in 100 over-65-year-old patients undergoing gastroscopy in our department from January to December 2012. They were randomly and equally divided into conventional gastroscopy group （n=50） and transnasal endoscopy group （n=50）, and then, every group was further divided into CHD subgroup （n=25） and control subgroup （without heart diseases, n=25）. The heart rate, blood pressure, arterial oxygen saturation, myocardial oxygen consumption and electrocardiogram during performance of endoscopy were compared between groups. Results During conventional gastroscopy, the increases of heart rate, blood pressure, and myocardial oxygen consumption, and the decrease of arterial oxygen saturation were significantly more obvious in CHD subgroup than the corresponding control subgroup （P〈0.05）. And, the incidences of arrhythmia and ST segment depression were higher in CHD subgroup than in control subgroup （P〈0.05）. For those receiving transnasal endoscopy, CHD patients had significantly mild increases in heart rate, blood pressure, and myocardial oxygen consumption, lower arterial oxygen saturation, and decreased incidences of arrhythmia and ST segment depression than the CHD patients undergoing conventional gastroscopy （P〈0.05）. Conclusion Transnasal endoscopy is well tolerated to elderly patients with CHD, and has fewer hemodynamic effects and higher safety.