麻醉肠镜在老年患者大肠息肉黏膜切除术中的应用

Anesthesia enteroscope application of endoscopic mucosal resection in elderly patients with colorectal polyps

目的探讨麻醉肠镜在老年患者大肠息肉行黏膜切除术(endoscopic mucosal resection,EMR)中的临床应用价值。方法将306例肠镜下发现大肠息肉的老年患者随机分为两组:麻醉肠镜组(156例);使用异丙酚和芬太尼行静脉麻醉;普通肠镜组(150例):仅给予肠道准备。观察两组患者EMR术前、中、后的血压[包括舒张压(SBP)、收缩压(DBP)]、心率(HR)、末梢血氧饱和度(Sp O2)和两组患者术中反应、并发症、手术操作时间及患者满意度。结果术中麻醉肠镜组SBP、DBP、HR均明显低于普通肠镜组(P均<0.05),Sp O2无显著差异(P>0.05);术前及术后两组患者SBP、DBP、HR、Sp O2均无显著性差异(P均>0.05)。麻醉肠镜组患者满意度高。麻醉组手术操作时间(18.1±6.3)min,普通组(24.4±8.5)min,两组比较,差异有统计学意义(P<0.05)。结论麻醉肠镜下对老年患者大肠息肉行EMR能够缩短操作时间,提高成功率,提高患者满意度,是一种治疗老年患者大肠息肉的简单、安全、有效的方法。

Objective To investigate the clinical value of endoscopic mucosal resection （EMR） treated with colorectal polyps in aged patients under painless colonoscopy.Methods A total of 306 aged patients with colorectal polyps were divided into two groups randomly：painless group （n =156） who received propofol and fentanyl to anesthesize,routine group（n =150）who received normal colonoscopy.The blood pressure （containt SBP,DBP）,heart rate （HR）and pulse oxygen saturation （SpO2） before,during and after the operation were recorded,and the reactions during operating,complications,the time of operating colonoscopy and satisfaction rate of the physicians to colonoscopy field of view were observed.Results There was no significant difference in SpO2 before,during and after the operation between two groups （P ＞ 0.05）.During operation,SBP,DBP,HR in painless group were lower than routine group （P ＜ 0.05）,but there was no significant difference between two groups before and after the operation.Patients had good tolerance for operation,no apparent adverse reactions during operation were shown in painless group,the vision was exposed fully.The time of operation were （18.1 ± 6.3） min in painless group,（24.4 ± 8.5） min in routine group,and there was statistic significance （P ＜0.05）.Conclusion EMR under painless colonoscopy can shorten curative time,increase the success rate and improve satisfaction rate of aged patients.EMR under painless colonoscopy is an easy,safe,effective method as a therapy for colorectal polyps.