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。？【Abstract】ObjectiveToobservetheeffectofpainlessgastroscopy-conscioussedationandintravenousanesthesiaontreatingesophagealvaricesorbleeding.MethodsFromNovember2004toMay2008,accordingtothediseaseconditionorpatient′srequirements,anesthetistsassessed13patientswhounderwentconscioussedationwiththeintravenousinjectionofmidazolam+fentanyl;30patientsunderwentintravenousanesthesiawithintravenousinjectionofmidazolam+propofol.Thirty-sixpatientsunderwentsettietreatment,andsevenunderwent1%aethoxysklerolinjectiontherapy.ResultsANofthe43patientscompletedthetreatmentsuccessfully,andtheemergencybleedingratewas100%(11/11).Fourweeksafterthetreatment,24caseshadapparenttherapeuticeffect,accountingfor55.8%;17patientshadeffect,accountingfor39.5%;2patientshadnoeffect;thetotaleffectiveratewas95.3%.Thepostoperativeforgottendegreeofthepatientsinintravenousanesthesiagroupwas100%.Thenausearatehappenedduringthemirrorsinsertingandtreatmentintheconscioussedationgroupwas76.9%and46.1%,respectively.Nohemorrhageoccurredinbothofthetowgroups.ConclusionPainlessendoscopicissafeandeffectiveforesophagealvarices.IntravenousanesthesiashouldbeusedinSclerotherapy.？