静脉全身麻醉后拔管行序贯无痛胃镜治疗食管胃静脉曲张出血的安全性研究

Safety of sequential painless gastroscopy after tube removal under intravenous general anesthesia for esophagogastric variceal bleeding

摘要:

目的 探讨食管胃静脉曲张破裂出血（EVB）应用三腔二囊管压迫止血，在静脉全身麻醉后拔管，即刻行序贯无痛胃镜治疗的安全性和治疗效果。方法 回顾性分析2020年1月－2024年12月该院应用三腔二囊管成功控制急性EVB，拔管后行序贯胃镜治疗的56例患者的临床资料。根据是否在静脉全身麻醉后拔管行无痛胃镜检查，将患者分为无痛拔管胃镜组（无痛组，27例）和清醒拔管胃镜组（清醒组，29例）。比较两组患者的安全性、临床疗效和胃镜治疗影响率。结果 治疗后，无痛组吸入性肺炎发生率为3.70%（1/27），与清醒组的3.45%（1/29）比较，差异无统计学意义（P = 0.944）；无痛组肝性脑病发生率为7.41%（2/27，均为Ⅰ期），与清醒组的0.00%（0/29）比较，差异无统计学意义（P = 0.228）；无痛组拔管出血率为11.11%（3/27），与清醒组的20.69%（6/29）比较，差异无统计学意义（P = 0.472）。其中，无痛组拔管后进镜时出血率为3.70%（1/27），低于清醒组的13.79%（4/29），但组间比较，差异无统计学意义（P = 0.353）。无痛组序贯胃镜治疗后近期再出血率为3.70%（1/27），与清醒组的6.90%（2/29）比较，差异无统计学意义（P = 0.596）。无痛组拔管刺激反应发生率为0.00%（0/27），明显低于清醒组的65.52%（19/29），差异有统计学意义（P = 0.000）。无痛组胃镜治疗影响率为7.41%（2/27），明显低于清醒组的44.83%（13/29），差异有统计学意义（P = 0.002）。结论 静脉全身麻醉后拔管即刻行序贯无痛胃镜治疗，不增加麻醉相关不良事件，可降低拔管刺激反应发生率和胃镜治疗影响率，可能进一步降低三腔二囊管拔管即刻的出血率和近期再出血率。值得应用于临床。

Abstract:

Objective To evaluate the safety and therapeutic efficacy of sequential painless gastroscopy following the removal of a Sengstaken-Blakemore tube under intravenous general anesthesia in patients with esophagogastric variceal bleeding (EVB) after successful tamponade.Methods A retrospective analysis was conducted on 56 patients with acute EVB successfully controlled by a Sengstaken-Blakemore tube between January 2020 and December 2024. Based on whether tube removal and gastroscopy was performed under intravenous general anesthesia， patients were divided into two groups: the anesthesia extubation gastroscopy group (painless group, n = 27) and the awake extubation gastroscopy group (waking group, n = 29). Safety outcomes, efficacy outcomes, and impact-related outcomes were compared between the two groups.Results The incidence of aspiration pneumonia post-treatment was 3.70% (1/27) in the painless group and 3.45% (1/29) in the waking group, showing no significant difference (P = 0.944). The incidence of hepatic encephalopathy post-treatment was 7.41% (2/27, all stage Ⅰ) in the painless group and 0.00% in the waking group, with no statistically significant difference (P = 0.228). The immediate rebleeding rate after tube removal was lower in the painless group (11.11%, 3/27) compared to the waking group (20.69%, 6/29), though the difference was not statistically significant (P = 0.472). Among them, the bleeding rate during endoscopy after extubation in the painless group was 3.70% (1/27), which was lower than 13.79% (4/29) in the waking group, but there was no statistically significant difference between the two groups (P = 0.353). Short-term rebleeding rate after sequential endoscopic therapy was 3.70% (1/27) in the painless group and 6.90% (2/29) in the waking group, with no significant difference (P = 0.596). The incidence of tube removal-induced stress reactions was 0.00% (0/27) in the painless group and 65.52% (19/29) in the waking group, demonstrating a statistically significant difference (P = 0.000). The interference rate with gastroscopic treatment was 7.41% (2/27) in the painless group and 44.83% (13/29) in the waking group, showing a statistically significant difference (P = 0.002).Conclusion Tube removal under anesthesia followed by sequential painless gastroscopy does not increase anesthesia-related adverse events, reduces the incidence of tube removal-induced stress reactions and interference with gastroscopic treatment, and may further decrease the immediate and short-term rebleeding rates after Sengstaken-Blakemore tube removal.