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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。
Objective To investigate the two ways of painless gastroscopy - the feasibility of treating esophageal varices or bleeding under conscious sedation and intravenous anesthesia. Methods November 2004 May 2008, according to the condition or patient requirements, 13 patients were conscious sedative intravenous midazolam fentanyl intravenous injection of 30 venous anesthesia or intravenous midazolam + Propofol. Of the 43 patients, 36 received ligation, and 7 received 1% ethoxylated alcohol injection. Results All the 43 cases were successfully treated. The emergency hemostasis rate was 100% (11/11). Four weeks after the treatment, 24 cases were markedly effective, accounting for 55.8%, 17 cases were effective, 39.5% were ineffective, and 2 cases were ineffective. The total effective rate was 95.3% . The degree of amnesia was 100% in the intravenous anesthesia group, while the pharyngeal sedation in the conscious sedation group and nausea in the treatment were 76.9% and 46.1%, respectively. No major bleeding occurred in both groups during and after treatment. Conclusion Painless endoscopy esophageal variceal treatment of security, the exact effect of sclerotherapy should be used intravenous anesthesia.