高原地区无痛胃镜下套扎治疗食管静脉曲张疗效研究

Safety and Efficacy of Treating Esophageal Varices with Painless Endoscopic Variceal Ligation at High Altitude Area

目的:探讨高原地区无痛胃镜下套扎治疗食管静脉曲张的安全性和疗效。方法:研究纳入94例肝硬化食管静脉曲张患者,共进行138例次内镜下套扎治疗,按患者自愿原则,将其分为两组,其中常规胃镜组50例,无痛胃镜组88例。无痛胃镜组在丙泊酚静脉麻醉状态下进行套扎治疗,普通胃镜组在清醒状态下进行套扎治疗。分别观察两组术前、术中、术后心率(HR)、呼吸(R)、血压(BP)、血氧饱和度(SPO2)变化,术前和术后7天肝功能及凝血酶原时间的变化,术后调查患者对胃镜下套扎治疗的耐受情况以及医生对术中内镜视野及操作的满意度。结果:1无痛胃镜组总有效率达100%,明显高于普通胃镜组的91.3%(P<0.01);2无痛胃镜组视野满意度明显优于普通胃镜组(P<0.001);3无痛胃镜组术中出血、术中咳嗽、恶心、呕吐、躁动等不良反应发生率比普通胃镜组明显减少(P<0.01);4无痛胃镜术中HR比术前减慢,SBP和DBP比术前下降,差异有统计学意义(均P<0.05);普通胃镜组术中HR比术前加快,SBP和DBP比术前升高,差异有统计学意义(P<0.05);R和SPO2术前、术中及术后均无明显变化(P>0.05);5两组患者术后7天肝功能、凝血酶原时间与术前比较无明显变化(P>0.05)。结论:普通胃镜套扎治疗食管静脉曲张效果肯定,但不良反应发生率较高,患者要承受较大的痛苦;无痛胃镜套扎治疗食管静脉曲张安全、舒适、不良反应少,术中视野清晰,效果好,但有一定的麻醉风险,在高原地区值得临床推广应用。

Objective： To study the safety and efficacy of treating esophageal varices with painless endoscopic variceal ligation at high altitude area. Methods： 94 liver cirrhosis patients with esophageal variceal bleeding were treated with endoscopic variceal ligation for 138 times and to observe the safety and efficacy. All patients were divided into 2 groups which were 50 patients in conventional endoscopy group and 88 patients in painless endoscopy group,respectively. Variceal ligation was carried out with propofol intravenous anesthesia in painless endoscopy group and no propofol intravenous anesthesia in general endoscopy group. Heat rate（ HR）,respiratory（ R）,blood pressure（ BP）,oxygen saturation of blood（ SPO2） were observed in preoperation,during operation and postoperation. Preoperation and 7 days postoperation of Liver function and prothrombin time were also observed. The patients＇ toleration to endoscopic ligation and the doctors＇ satisfaction to endoscopic view field during operation were also investigated. Results：①Total response rate is 100% in painless endoscopy group compared with 91. 3% in general endoscopy group（ P〈0. 01）; ②View field of operation in painless endoscopy group is better than that in general endoscopy group（ P〈0. 01）; ③Adverse reactions such as bleeding,coughing,nausea,vomit,restlessness during operation in painless endoscopy group were less than general endoscopy group obviously（ P〈0. 01）; ④HR,SBP,DBP in painless endoscopy group decreased compared with preoperation（ P〈0. 05）. HR,SBP,DBP in general endoscopy group increased compared with preoperation（ P〈0. 05）. There were no obvious changes of R and SPO2 during preoperation,inoperation and postoperation（ P〈0. 05）; ⑤The liver function,prothrombin time of 7 days after operation were the same between two groups（ P〈0. 05）. Conclusions： General endoscopic variceal ligation has positive effect on treating esophageal varices,but face to higher adverse reactions. Painless endoscopic variceal ligation has advantages of safety,comfortable,painless,good view field during operation and less adverse reactions,but risks of anesthesia need to be avoided. Generally,because of safety,comfortable,painless and less adverse reactions,painless endoscopic variceal ligation is worth to be performed at high altitude area.