深镇静下监测麻醉对消化内镜检查的影响分析

Effects of monitored anesthesia care with deep sedation on gastrointestinal endoscopy

目的探讨麻醉管理介入对消化内镜检查操作是否存在无痛之外的其他获益。方法对2010年9月至2015年9月在北京大学人民医院接受消化内镜检查及治疗的所有患者进行检索。依照是否实施深镇静下监测麻醉（DS—MAC）分为普通组及MAC组。选取该时段所有行上消化道内镜异物取出术的患者，对比两组的操作成功率；选取2014年9月至2015年9月所有行上消化道内镜检查的患者，对比两组食管上段胃黏膜异位的检出率；选取2014年9月至2015年9月行普通消化内镜检查及MAC消化内镜检查的术间各一间，对比两组各自然月行消化内镜检查的例数。结果MAC组操作成功率高于普通组（100．0％比89．7％，x2=11．737，P=0．001）；MAC组食管上段胃黏膜异位检出率高于普通组（4．3％比1．7％，x2=58．751，P〈0．001）；MAC组每月行消化内镜检查例数高于普通组[（350．2±36．2）例比（213．2±27．9）例，t=17．591，P〈0．001]。结论深镇静消化内镜检查可提高操作的成功率、精准度及操作速度，推广内镜检查过程中麻醉管理的介入是有益的。

Objective To explore effects of monitored anesthesia care （MAC） on gastrointestinal endoscopy. Methods All patients who underwent gastrointestinal endoscopy in Peking University People＇s Hospital from September 2010 to September 2015 were analyzed retrospectively and divided into two groups： the MAC group and control group by usage of MAC. Success rates of removal of foreign bodies by upper gastrointestinal endoscopy were compared between two groups during this period. Detection rates of ectopia of gastric mucosa in upper esophagus were compared between two groups from September 2014 to September 2015 when esophagogastroduodenoscopy was performed. The monthly cases of gastrointestinal endoscopies were compared between the two groups, which were separately collected from one MAC operating table and one routine operating table from September 2014 to September 2015. Results The success rate of removal of foreign bodies in the MAC group was higher than that in the control group（ 100. 0% VS 89. 7% 2（2 = 11. 737, P=0. 001）.The detection rate of ectopia of gastric mucosa in upper esophagus in the MAC group was higher than that in the control group（4. 3% VS 1.7% ,x2 = 58. 751, P〈0. 001）. The monthly cases of gastrointestinal endoscopies in the MAC group was higher than that in the control group（ 350. 2±36. 2 cases VS 213. 2±27. 9 cases,t = 17. 591, P〈0. 001 ）. Conclusion The use of MAC for gastrointestinal endoscopy improves operating success rate, accuracy and operating time. MAC in gastrointestinal endoscopy can be recommended.