不同麻醉方式下直视胃镜检查上消化道微小病变检出率的比较

The Comparison of the Detection Rate of Microlesions in Gastroscopy under Different Anesthesia Modes

目的探讨直视胃镜检查中应用不同麻醉方式的临床价值。方法选取2015年1月—2015年12月在医院消化内镜中心行直视胃镜检查的患者为观察对象,分为丙泊酚静脉麻醉组和表面麻醉组,比较分析两组患者上消化道微小病变的检出率及心血管呼吸系统不良事件的发生率。结果丙泊酚静脉麻醉组上消化道检查完成率99.95%,表面麻醉组上消化道检查完成率99.81%,两组比较有统计学差异(P<0.05);丙泊酚静脉麻醉组微小病变的总检出率明显高于表面麻醉组(P<0.05);贲门、食管上端、十二指肠球降交接处病变检出率丙泊酚静脉麻醉组亦明显高于表面麻醉组(P<0.05);早期食管癌的发现率丙泊酚静脉麻醉组明显低于表面麻醉组(P<0.05);丙泊酚静脉麻醉组较表面麻醉组在胃镜检查中低氧血症、心动过缓、低血压的发生率高(P<0.05)。结论对门诊行直视胃镜检查患者而言,丙泊酚静脉麻醉较表面麻醉更有利于患者完成胃镜检查以及贲门、食管上段、十二指肠球降交接部位微小病变的检出,但低氧血症、心动过缓、低血压不良事件的发生率偏高,须由有经验的麻醉医生进行有效术前评估及应用合理的麻醉药物与方法以减少潜在的不良事件。两种麻醉方式对于上消化道早期癌发现率的影响还有待进一步的临床研究。

Objective To compare the incidence of minimal lesions of the upper gastrointestinal tract and the inci-dence of adverse events of the cardiovascular respiratory system in patients undergoing direct gastroscopy under different anes-thesia methods, and to explore the clinical value of the anesthesia in direct gastroscopy. Methods The patients were divided into propofol intravenous anesthesia group and topical anesthesia group, compared the diagnosis of minimal lesion in upper di-gestive tract and the incidence of adverse events in cardiovascular respiratory system between the two groups. Results The completed rate in propofol intravenous anesthesia group was 99. 95% significantly higher than topical anesthesia group with 99. 81 % （ P 〈 0. 05 ）. The incidence of minimal lesions in propofol intravenous anesthesia group was significantly higher than that in patients undergoing topical anesthesia （ P 〈 0. 05 ）. The detection rate of early esophageal cancer was significantly low-er in propofol intravenous anesthesia group than in surface anesthesia group （ P 〈 0. 05 ） . The incidence of cardia, esophageal upper and duodenal ball junctions in propofol intravenous anesthesia group was significantly higher than that of surface anes-thesia group （P 〈0. 05）. The incidence of hypoxemia, bradycardia and hypotension in patients with propofol intravenous an-esthesia group was higher than that in patients with superficial anesthesia （P 〈0. 05） . Conclusion For patients undergoing direct vision gastroscopy in the outpatient department, compared with surface anesthesia, propofol intravenous anesthesia is more conducive to complete gastroscopy, the detection of small lesions in the cardia, upper esophagus, duodenal bulb, and early esophageal cancer, but the incidence of hypoxemia, bradycardia and hypotension is higher, and it is necessary to make effective preoperative assessment and choose rational anesthetic drugs and methods by experienced anesthesiologist to reduce the potential adverse events. The effect of two kinds of anesthesia on the rate of early detection of upper gastrointestinal tract cancer remains to be further studied.