无痛胃镜下治疗食管静脉曲张疗效观察

目的探讨无痛胃镜两种方式——清醒镇静和静脉麻醉下治疗食管静脉曲张或出血的可行性。方法 2004年11月2008年5月,根据病情或患者要求,对13例患者行清醒镇静即静脉推注咪达唑仑＋芬太尼,30例行静脉麻醉即静脉推注咪达唑仑＋丙泊酚。43例患者中36例行套扎治疗,7例行1%乙氧硬化醇注射治疗。结果 43例均成功完成治疗,急诊止血率100%（11/11）,治疗后4周复查,显效24例,占55.8%,有效17例,占39.5%,无效2例,总有效率95.3%。静脉麻醉组术后遗忘度100%,清醒镇静组插镜过咽和治疗过程中发生恶心分别为76.9%、46.1%。两组患者在治疗过程中及治疗后均未发生大出血。结论无痛胃镜下行食管静脉曲张治疗安全、疗效确切,以硬化剂注射治疗者应采用静脉麻醉。

Therapeutic Effect of the Treatment Using Painless Gastroscope on Esophageal Venous Varices

Objective To observe the effect of painless gastroscopy-conscious sedation and intravenous anesthesia on treating esophageal varices or bleeding.Methods From November 2004to May 2008,according to the disease condition or patient＇s requirements,anesthetists assessed 13patients who underwent conscious sedation with the intravenous injection of midazolam＋fentanyl;30patients underwent intravenous anesthesia with intravenous injection of midazolam＋propofol.Thirty-six patients underwent set tie treatment,and seven underwent 1%aethoxysklerol injection therapy.Results AN of the 43patients completed the treatment successfully,and the emergency bleeding rate was 100% （11/11）.Four weeks after the treatment,24cases had apparent therapeutic effect,accounting for 55.8%; 17patients had effect,accounting for 39.5%;2patients had no effect;the total effective rate was 95.3%.The postoperative forgotten degree of the patients in intravenous anesthesia group was 100%.The nausea rate happened during the mirrors inserting and treatment in the conscious sedation group was 76.9%and 46.1%,respectively.No hemorrhage occurred in both of the tow groups.Conclusion Painless endoscopic is safe and effective for esophageal varices. Intravenous anesthesia should be used in Sclerotherapy.