无痛胃镜检查临床应用的探讨

The Exploration about the Clinical Application of Painless Gastroscope

摘要:

目的 探讨临床上应用无痛胃镜和普通胃镜两种检查方式的异同及取舍原则。方法 1 600例拟行胃镜检查患者按自愿原则分为两组,无痛胃镜组800例,采用丙泊酚单一药物静脉麻醉进行胃镜检查,普通胃镜组800例仅予以常规胃镜操作。检查前应用焦虑自评量表(SAS)行焦虑程度评估,比较不同焦虑程度的患者检查后的主观感受和接受再检查率及两组焦虑程度改变。观察记录两组患者检查中的不良反应以及血压、心率、呼吸和血氧饱和度的变化情况。结果38.25%的受检者在胃镜检查前存在着不同程度的焦虑心理,女性伴焦虑者比男性多(P＜0.001)；检查后无痛胃镜组患者的焦虑程度比普通胃镜组明显减轻(P＜0.0001),焦虑程度高的患者存在难以忍受感且接受再检查率明显减少。检查中,无痛胃镜组出现的咽喉不适、恶心呕吐、躁动等不良反应发生率低,两组比较差异有显著性(P＜0.001)。无痛胃镜组收缩压、心率和呼吸最高值低于普通胃镜组,血氧饱和度(SpO₂)最低值有所下降,但SpO₂变化及其最高值两组相比差异无显著性(P＞0.05)；与检查前相比,无痛胃镜组血压、心率、呼吸有下降,而普通胃镜组上述监测指标则均有升高(P＜0.05)。结论内镜医师在建议患者选择胃镜检查方式时,要严格把握适应症,不仅要满足患者检查时的舒适度,更要确保其安全性。

Abstract:

Objective To explore the similarities and differences between the painless and ordinary gastroscopy in clinical application and the choice principles.Methods1600 cases of patients who were going to recept gastroscopy were divided into two groups according to voluntary principle,the observation group(painless gastroscope group)with 800 cases,using single drug propofol intravenous anesthesia for gastroscopy,the control group (ordinary gastroscope group)with 800 cases only receiving routine gastroscopy.Before gastroscopy,each member needs to apply the self rating Anxiety Scale(SAS) to assess the degree of anxiety,to compare the degree of anxiety in patients with different anxiety levels before and after the examination,and the subjective experience and the rate of reexamination and the change of the degree of anxiety in the two groups after the examination of the patients with different degree of anxiety.Adverse effects and changes in blood pressure,heart rate,respiration and blood oxygen saturation were observed in two groups of patients and recorded in the inspection.Results38.25% subjects have different anxiety levels before gastroscopy.Anxiety accompanies females higher than males(P＜0.001);There was a significant decrease of the anxiety degree in the observation group than the control group after examination(P＜0.001).A high degree of anxiety patients with unbearable sense and accept there inspection rate was significantly reduced.In the examination,the observation group of the throat discomfort,nausea,vomiting,agitation and other adverse reaction rate is lower,the difference between the two groups has significance(P＜0.001).In observation group,systolic blood pressure,heart rate,respiratory rate and the highest value was lower than that of the control group,the blood oxygen saturation(SpO₂) minium value declined,but SpO₂ and the highest value of two phase contest was not different(P＞0.05);compared with before the examination,in the observation group,the blood pressure,heart rate and respiration were in decline,while the control group,the monitoring indicators were increased(P＜0.05).ConclusionEndoscopic physicians have to grasp the indications strictly about how to choose the way of gastroscopy,not only to meet the comfort of the examination,but also to ensure the safety of patients.