无痛内镜下食管胃静脉曲张治疗术对轻微肝性脑病的影响

Effect of painless endoscopic treatment of esophageal and gastric varices on mild hepatic encephalopathy

摘要:

目的 探讨无痛内镜下食管胃静脉曲张治疗术（组织胶注射+套扎或组织胶+硬化剂注射）对轻微肝性脑病（MHE）的影响。方法 采用前瞻性队列研究，将92例食管胃静脉曲张患者分为MHE组（n = 44）和无肝性脑病组（对照组，n = 48）。采用数字连接试验（NCT）、数字符号试验（DST）评估两组患者术前、术后2 h和术后24 h MHE的发生情况和术后麻醉复苏时间。结果 MHE组术后NCT评分和DST评分与术前比较，差异均无统计学意义（P > 0.05）。对照组术后NCT评分及DST评分与术前比较，差异均无统计学意义（P > 0.05）。MHE组麻醉复苏时间平均为（7.2±2.7）min，对照组平均为（6.9±3.5）min，两组比较，差异无统计学意义（P > 0.05）。结论 食管胃静脉曲张内镜术中使用丙泊酚联合瑞芬太尼对MHE无明显影响，且不会诱发显性肝性脑病（OHE），是一种安全、舒适的方式，值得在临床中推广应用。

Abstract:

Objective To investigate the effect of painless endoscopic liver cirrhosis esophagogastric varices treatment (tissue glue injection and ligation or tissue glue and sclerosant injection) on mild hepatic encephalopathy (MHE).Methods Using a prospective cohort study, 92 patients with esophagogastric varices were divided into MHE group (n = 44) and non-hepatic encephalopathy group (control group, n = 48). All the patients occurrence of mild hepatic encephalopathy (MHE) before surgery, 2 h after surgery, and 24 h after surgery, and the anesthesia recovery time were evaluated by number connection test (NCT) and digital symbol test (DST).Results There was no significant difference in postoperative NCT score and DST score in the MHE group compared with preoperative (P > 0.05). The NCT score and DST score of the control group after operation were also not significantly different from those before the operation (P > 0.05). In terms of anesthesia resuscitation time, the MHE group required an average of (7.2 ± 2.7) min and the control group an average of (6.9 ± 3.5) min, there was no statistically significant difference between the two groups (P > 0.05).Conclusion The use of Propofol combined with Remifentanil in endoscopic surgery for esophagogastric varices has no significant effect on MHE and does not induce overt hepatic encephalopathy (OHE). It is a safe and comfortable method, and it is worthy of clinical promotion.