表面或静脉麻醉下经胃镜食管静脉曲张结扎术患者的利弊比较

目的 探讨在表面或静脉麻醉下经胃镜行食管静脉曲张结扎术中患者的安全性和注意事项。方法 随机选择常规组和静脉组患者各50例，观察在两种方法下患者生命体征的变化，对胃镜插入刺激的耐受性，操作时间，临床不良反应。结果 常规组操作中的呼吸、心率及血压较麻醉前（P〈0．05）和此时段的静脉组升高（P〈0．05）。常规组呕吐反应、自主拔管行为、食管黏膜损伤和静脉曲张破裂出血发生率分别为52％、18％、20％和8％．视野祛泡率更高（P〈0．05）。静脉组耐受性更好；操作时间更短（P〈0．05）；临床不良反应更少。结论 由经验丰富的内镜和麻醉医师共同完成静脉麻醉下食管静脉曲张结扎术是安全、快速有效的，更有利于检查和治疗。但应警惕突发静脉曲张破裂出血，随时做好急救准备。

Comparison of advantages and disandvantages during gastroscopic ligation in patients with esophageal varices under topical or intravenous anesthesia

Objective] To study the security and precautions of patients during gastroscopic esophageal variceal ligation under topical or intravenous anesthesial. Methods] Patients were randomly divided into routine or intravenous group, 50 persons each. Under two methods, the change of vital signs, the tolerance to stimulation of gastroscopy, the time of operating, clinical adverse reaction were all recorded. Results] There were more significant increasing in RR,HR,MAP during operating than pre-anesthesia in routine group(P<0.05), and than in same time in intravenous group(P<0.05). The vomiting, extubate by oneself, injuring of esophageal and variceal bleeding rate were 52%, 18%, 20% and 8%, respectively, in routine group. The rate of dispelling saliva bubbles of operating vision was higher in routine group than in intravenous group (P <0.05). There were better tolerance to gastroscopy, shorter time of operating (P<0.05), minor clinical adverse reaction, and it was accepted by endoscopists and patients well, in intravenous group. Conclusions] The esophageal variceal ligation by experienced endoscopist combined with anesthtists can be achieved safely, rapidly and effectively. It can remove ill stimulation of cirrhotic patiants induced by routine gastroscopy and be more beneficial to examination and treatment and should be on guard against variceal bleeding suddenly, get ready for emergency treatment at any time.