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目的:探讨高原地区无痛胃镜下套扎治疗食管静脉曲张的安全性和疗效。方法:研究纳入94例肝硬化食管静脉曲张患者,共进行138例次内镜下套扎治疗,按患者自愿原则,将其分为两组,其中常规胃镜组50例,无痛胃镜组88例。无痛胃镜组在丙泊酚静脉麻醉状态下进行套扎治疗,普通胃镜组在清醒状态下进行套扎治疗。分别观察两组术前、术中、术后心率(HR)、呼吸(R)、血压(BP)、血氧饱和度(SPO2)变化,术前和术后7天肝功能及凝血酶原时间的变化,术后调查患者对胃镜下套扎治疗的耐受情况以及医生对术中内镜视野及操作的满意度。结果:1无痛胃镜组总有效率达100%,明显高于普通胃镜组的91.3%(P<0.01);2无痛胃镜组视野满意度明显优于普通胃镜组(P<0.001);3无痛胃镜组术中出血、术中咳嗽、恶心、呕吐、躁动等不良反应发生率比普通胃镜组明显减少(P<0.01);4无痛胃镜术中HR比术前减慢,SBP和DBP比术前下降,差异有统计学意义(均P<0.05);普通胃镜组术中HR比术前加快,SBP和DBP比术前升高,差异有统计学意义(P<0.05);R和SPO2术前、术中及术后均无明显变化(P>0.05);5两组患者术后7天肝功能、凝血酶原时间与术前比较无明显变化(P>0.05)。结论:普通胃镜套扎治疗食管静脉曲张效果肯定,但不良反应发生率较高,患者要承受较大的痛苦;无痛胃镜套扎治疗食管静脉曲张安全、舒适、不良反应少,术中视野清晰,效果好,但有一定的麻醉风险,在高原地区值得临床推广应用。
Objective: To investigate the safety and curative effect of laparoscopic treatment of esophageal varices under painless endoscopy in the plateau. Methods: A total of 94 patients with esophageal varices of liver cirrhosis were enrolled in this study. A total of 138 patients underwent endoscopic ligation. Patients were divided into two groups according to their voluntary principles. Among them, 50 were conventional gastroscopy and 88 were painless gastroscopy . Painless gastroscopy group in the propofol intravenous anesthesia ligation, general gastroscopy group in the awake state ligation. The changes of heart rate (HR), respiration (R), blood pressure (BP) and oxygen saturation (SPO2) before and after surgery were observed. The liver function and prothrombin time Of the changes in postoperative patients underwent gastroscopic ligation treatment and the doctor on the endoscopic vision and operation satisfaction. Results: 1 The total effective rate of painless gastroscopy group was 100%, which was significantly higher than 91.3% (P <0.01) of conventional gastroscope group. 2 The satisfaction of visual acuity of painless gastroscope group was significantly better than that of common gastroscope group (P <0.001); 3 Painless gastroscopy group intraoperative bleeding, intraoperative cough, nausea, vomiting, restlessness and other adverse reactions were significantly lower than the average gastroscopy group (P <0.01); 4 painless gastroscopy in patients with preoperative HR slowed down, SBP and DBP (P <0.05). HR in HR group was higher than that in preoperative group, SBP and DBP were significantly higher than those in preoperative group (P <0.05); R and There was no significant difference in preoperative, postoperative and postoperative SPO2 (P> 0.05) .5 The hepatic function and prothrombin time in the two groups showed no significant change at 7 days after operation (P> 0.05). Conclusion: Gastroscopy ligation is effective in the treatment of esophageal varices, but the incidence of adverse reactions is high, patients should suffer greater pain. Painless gastroscope ligation is safe and comfortable for patients with esophageal varices, with few adverse reactions and clear intraoperative visual field , Good effect, but there is a certain risk of anesthesia in the plateau worthy of clinical promotion and application.