无痛胃肠镜检查和治疗术的临床应用研究

Clinical application and research on inspection and treatment of painless gastroscopy

目的:研究小剂量咪唑安定和异丙酚联合应用在胃肠镜检查和治疗中的可行性和安全性。方法:①2140例胃镜检查患者给予咪唑安定和异丙酚静脉复合麻醉为实验组,1000例常规操作为对照组,②将600例结肠镜检查患者随机分为两组:静脉复合麻醉组(350例)静脉注射咪唑安定、芬太尼及异丙酚至患者进入4级镇静状态后进行结肠镜检查。对照组(250例)按常规进行结肠镜检查,比较两组患者的反应、操作时间及检查前中后血压、心率及氧饱和度的变化。③治疗组:在无痛胃肠镜状态下开展息肉摘除、贲门失弛缓症内镜下扩张治疗、食管静脉曲张套扎治疗及EST共51例。结果:①胃镜静脉复合麻醉组咳嗽、恶心呕吐的发生率分别为1.7％、0.53％,而对照组为46.6％、11.6％(P<0.001),静脉复合麻醉组清醒时间为8.95±2.95min,检查中血压、心率及氧饱和度平稳。②肠镜检查中复合麻醉组与对照组相比血压无明显变化(P<0.05);入镜时间明显优于对照组(P<0.01)。③全部治疗组无并发症发生,患者依从性好,治疗时间明显缩短。结论:小剂量咪唑安定和异丙酚及芬太尼联合应用于胃肠镜检查安全、有效。尤其有利于开展胃肠镜下治疗,此项技术深受患者欢迎,推广和应用此项技术必将产生巨大的社会和经济效益。

Objective: To research the feasibility and safety of joint application of mini-dosage imidazole valium and propofol during gastrointestinal endoscopic procedures. Methods: ① 2140 cases of gastroscopy undertaking combined anesthesia of imidazole valium and propofol, the comparing 1000 cases undertaking routine procedures.② Divided the 600 cases of colonoscopy into two groups: the vein combined anesthesia group (350 cases), conduct colonoscopy inspection to the patients stepping into the 4th level sedation after intravenous injection of imidazole valium, fentanyl and propofol; the comparison group(250 cases), colonoscopy inspection according to routine procedures,observe the blood pressure,oxygen saturation and inserting time before,in and after colonoscopy. ③Treatment group:51 cases in total, 14 cases of esophageal polyp and dubdenum polyp treated with high frequency electro-cutter gastroscope, 22 cases of colonic polyp treated with electro-cutter, 11 cases of expansion treatment for cardia achalasia,2 cases for binding treatment for oesophagus varices,and 2 cases for EST.Results:①The incidence of cough and nausea in the vein combined anesthesia group was 1.7% and 0.53%vs46.6% and 11.6% in comparison group(P < 0.001);In the painless sedation group, the clear-headed period was(8.95 ± 2.95)min,and the blood pressure, heart rate and oxygen saturation were normal. ②The blood pressure did not obviously change in the combined anesthesia group. ③ No complication in treatment group, good compliance, obvious shortening of inspection time.Conclusion: The combination of mini-dosage imidazole valium, propofol and fentanyl in gastroentestinal endoscopy is safe and effective. The introduction of painless gastroentertinal endoscopy is especially favourable for the treatment endoscopy. The treatment period is also shortened, the popularisation and application of the painless gastrointestinal endoscopy will undoubtedly bring about great social and economic benefits.