静脉麻醉对诊断性胃镜检查中病变检出率的影响--基于倾向性得分匹配的回顾性研究

The effect of intravenous anesthesia on the detection rate of lesions in diagnostic gastroscopy:a retrospective study based on propensity score matching

目的探讨静脉麻醉对诊断性胃镜检查中病变检出率的影响。方法选取2021年3月至2022年2月在扬州大学附属医院消化内镜中心进行诊断性胃镜检查的受试者9071例。从胃镜质控系统收集受试者年龄、性别、检查医师、幽门螺杆菌感染、检查方式、退镜时间、留图数目、活检次数、活检部位、胃镜诊断、病理诊断等资料,根据检查方式分为麻醉组和普通组,对两组受试者进行倾向性得分匹配(PSM),排除混杂因素,分析两组受试者在病变部位、病变类型方面的检出情况;同时采用单因素及多因素logistic回归分析上消化道癌前病变及恶性肿瘤检出率的影响因素。结果经过PSM,两组各纳入1655例受试者,在病变部位方面,麻醉组对胃体病变的检出率高于普通组(P<0.05),对食管病变的检出率低于普通组(P<0.05);在病变类型方面,麻醉组对胃息肉、黏膜隆起性病变、黏膜萎缩、肠化等癌前病变的检出率均高于普通组(均P<0.05)。Logistic回归分析结果发现,静脉麻醉是诊断性胃镜检查中癌前病变及恶性肿瘤检出率的独立影响因素(OR=1.338,95%CI:1.070~1.674,P<0.05)。结论静脉麻醉是诊断性胃镜检查中癌前病变及恶性肿瘤检出率的独立影响因素,且能提高上消化道病变检出率。

Objective To investigate the effect of intravenous anesthesia on the detection rate of lesions in diagnostic gastroscopy.Methods A total of 9071 subjects who underwent diagnostic gastroscopy at the Digestive Endoscopy Center of Yangzhou University Affiliated Hospital from March 2021 to February 2022 were selected.Data were collected from the gastroscopy quality control system,including age,gender,examination physician,Helicobacter pylori infection,examination method,withdrawal time,number of images left,number of biopsies,biopsy site,gastroscopy diagnosis,pathological diagnosis,etc.They were divided into anesthesia group and general group based on the examination method,and propensity score matching(PSM)was performed on the two groups of subjects.Excluding confounding factors,the detection of lesion location and lesion type in two groups of subjects was analyzed;Simultaneously,univariate and multivariate logistic regression analysis was used to analyze the influencing factors of the detection rate of precancerous lesions and malignant tumors in the upper gastrointestinal tract.Results After PSM,1655 subjects were included in both groups.In terms of lesion location,the detection rate of gastric body lesions in the anesthesia group was higher than that in the general group(P<0.05),and the detection rate of esophageal lesions in the anesthesia group was lower than that in the general group(P<0.05);In terms of lesion types,the detection rate of precancerous lesions such as gastric polyps,mucosal protrusions,mucosal atrophy,and intestinal metaplasia in the anesthesia group was higher than that in the general group(all P<0.05).The results of logistic regression analysis showed that intravenous anesthesia was an independent influencing factor for the detection rate of precancerous lesions and malignant tumors in diagnostic gastroscopy(OR=1.338,95%CI:1.070-1.674,P<0.05).Conclusions Intravenous anesthesia is an independent influencing factor for the detection rate of precancerous lesions and malignant tumors in diagnostic gastroscopy,and can improve the detection rate of upper gastrointestinal lesions.