不同肝功能分级肝硬化患者行无痛胃镜食管静脉曲张套扎术安全性及疗效对比

Comparison of safety and efficacy of painless esophageal variceal ligation by sedation endoscopy on liver cirrhosis patients with different liver function classification

目的探讨肝硬化患者不同肝功能分级行无痛胃镜食管静脉曲张套扎术(EVL)麻醉安全性及近期疗效,为临床治疗提供参考。方法收集粤北人民医院2009年1月至2017年6月收治的124例肝硬化并食管静脉曲张行无痛胃镜EVL患者,按术前肝功能Child-Pugh分级分组,49例肝功A级为A组,46例B级为B组,29例C级为C组;对比分析三组麻醉安全性指标:麻醉效果、生命体征变化(血压、心率、血氧饱和度)、严重麻醉意外事件;近期疗效指标:手术成功率、术中大出血、术后感染、术后1个月内出血、围手术期死亡。结果三组麻醉效果优占率比较,差异无统计学意义(χ~2=1.282,P=0.548)。三组间术前、术中、术后的收缩压、舒张压、心率、血氧饱和度比较,差异均无统计学意义(P>0.05);各组术中、术后的血压、心率、血氧饱和度水平与本组术前比较,差异均无统计学意义(P>0.05)。三组手术成功率、术中大出血率、术后感染率、术后1个月内出血率和围手术期死亡率比较,差异无统计学意义(P>0.05)。结论术前掌握好无痛胃镜套扎适应证,不同肝功能分级麻醉均安全、麻醉效果满意,手术近期疗效可、并发症少;但肝功能C级注意预防可控呼吸抑制。

Objective To compare the safety and efficacy of esophageal variceal ligation(EVL) by painless sedation endoscopy on liver cirrhosis patients with different liver function classification. Methods Totally 124 patients with liver cirrhosis and esophageal varices who prefer to EVL by painless sedation endoscopy from January 2009 to June 2017 were collected and divided into three groups according to Child-Pugh scores of liver function: group A(n=49), group B(n=46), group C(n=29). Safety indicators including efficacy of sedation, changes of vital signs(heart rate, blood pressure, blood oxygen saturation) and severe anaesthesia acciden were observed. Short-term effective indicators including success rate of operation, intraoperative hemorrhage, postoperative infection, postoperative hemorrhage within 1 month, peri-operative death were observed. Results There was no significant difference among the three groups in the rate of anaesthesia effect(P>0.05). There were no significant differences among the three groups in preoperative, intraoperative, and postoperative heart rate, blood pressure and blood oxygen saturation(P>0.05), and there were no significant difference in blood pressure, heart rate and blood oxygen saturation before and after operation in each group(P>0.05).There were no significant differences among the three groups in the success rate of operation, intraoperative hemorrhage, postoperative infection, postoperative hemorrhage within 1 month and the perioperative death rate(P>0.05). Conclusion As long as the indications of painless EVL were grasped before operation, painless sedation endoscopy is a safe and effective sedation method, and the operation of EVL has good short-term curative effect and few complications, but controlled respiratory inhibition should be prevented in patients with Child-Pugh C grade.