早期麻醉诱导下气管插管辅助急诊床边胃镜诊治急性非静脉曲张性上消化道大出血

Experience in emergency endoscopy under general anesthesia in diagnosis and treatment of acute non-variceal upper gastrointestinal hemorrhage

目的探讨麻醉诱导下气管插管辅助急诊床边胃镜诊治急性非静脉曲张性上消化道大出血的方法和疗效。方法回顾性分析2013年1—10月我科收治的25例急性非静脉曲张性上消化道大出血患者的临床资料，先经2—6h生命体征支持治疗后，于人院12h内生命体征稳定后采取麻醉诱导下气管插管辅助急诊床边胃镜诊治，记录操作前后患者生命体征变化情况，止血成功率、操作时间、并发症及死亡率。结果24例经胃镜下明确出血部位和原因（内镜下一次性止血成功22例，内镜下2次止血成功1例，内镜下止血后2d再次出血行血管介入治疗1例），内镜下确诊率96％（24／25），一次性成功止血率88％（22／25），总有效率92％（23／25）。另1例胃镜下未能明确出血原因，转急诊手术。内镜下操作时间20。120（40±15）min，所有患者在内镜操作前后的生命体征变化比较，差异无统计学意义（P〉0．05）。本组无内镜操作相关并发症，无死亡病例。结论持续麻醉诱导下气管插管急诊床边胃镜诊治急性非静脉曲张性上消化道大出血，解决了患者清醒状态下配合性较差、操作难度较大等问题，并具有较好的安全性和有效性。

Objective To investigate the application experience in emergency endoscopy under general anesthesia in diagnosis and treatment of acute non-variceal upper gastrointestinal hemorrhage （ANVUGIH）. Methods The clinical data of 25 patients di- agnosed with ANVUGIH in Fuzhou General Hospital from Jan. to Oct. 2013 were retrospectively analyzed. All the patients un- derwent emergency endoscopy under general anesthesia as soon as the blood pressures were normal within 12 hours after 2 -6 h VS supportive treatment. Then diagnosis rates, endoscopic operation time, change in vital signs, rebleeding rate and complica- tion were recorded down. Results Twenty-four cases were diagnosed with emergency endoscopy （22 cases underwent hemostatic treatment under emergency endoscopy successfully at the first time, 1 case successfully at the second time. 1 patient occurred rebleeding 2 days after endoscopic operation. 1 patient received surgical operation）, the endoscopic diagnosis rate was 96% （24/25） , the whole successful hemostatic rate was 88% （22/25） and the total efficiency was 92% （23/25）. No complica- tion and death happened. The time of endoscopic operation was 20 - 120 （40 ± 15） min. The change in vital signs during en- doscopic operation was of no significant difference （ P 〉 0.05 ）. Conelusion The emergency endoscopy under general anesthe- sia may be a safe and efficacious method to diagnosis and treatment of ANVUGIH, by resolving physical discomfort and anxiety that often accompany an endoscopic operation.