廖锦文　赵伟　张静

[摘要] 目的 總结笑气清醒镇静辅助胃镜治疗上消化道异物的有效性及安全性，为其临床推广提供经验。 方法 回顾性分析我院2014年6月～2016年5月门诊消化内镜就诊的食管异物的患者214例，随机分为研究组和参照组，研究组为自愿接受笑气清醒镇静胃镜治疗上消化道异物的患者107例，参照组为普通胃镜治疗上消化道异物的患者107例，对两组患者治疗术后反应情况及治疗前、中、后收缩压、舒张压、心率及血氧饱和度变化进行比较。 结果 两组患者均顺利完成治疗，研究组的SBP、DBP、HR及SpO2变化低于参照组，组比较差异有统计学意义（均P<0.01）；研究组不良反应发生率25.23%（27例），明显低于参照组为43.92%（47例），差异有统计学意义（χ2=8.26，P<0.01）；研究组102例（95.3%）患者愿意再次接受治疗，显著高于参照组92例（86.0%），差异有统计学意义（χ2=5.52，P<0.01）。 结论 笑气清醒镇静辅助胃镜治疗上消化道异物，提高了治疗的舒适度，且操作简单、安全，值得推广应用。

[关键词] 笑气；清醒镇静；胃镜治疗；上消化道异物

[中图分类号] R573 [文献标识码] B [文章编号] 1673-9701（2017）28-0069-03

[Abstract] Objective To summarize the effectiveness and safety of the nitrous oxide conscious sedation assisted with gastroscopy in the treatment of upper gastrointestinal tract， and to provide experience for the clinical promotion. Methods 214 patients with esophageal foreign body admitted in digestive endoscopy clinics from June 2014 to May 2016 were retrospectively analyzed. The patients were randomLy divided into study group and control group. 107 patients with upper digestive tract foreign body who voluntarily accepted nitrous oxide conscious sedation assisted with gastroscopy were selected as the study group. 107 cases of upper digestive tract foreign body treated with ordinary gastroscopy were selected as the control group. The reaction situation after surgery， the changes of systolic blood pressure， diastolic blood pressure， heart rate and oxygen saturation between the two groups of patients were compared before treatment， during and after treatment. Results Two groups both successfully completed the treatment. The levels of SBP， DBP， HR and SpO2 in the study group were significantly lower than those in the control group， and the difference was significant（P<0.01）. The incidence of adverse reactions was 25.23%（n=27）， which was significantly lower than 43.92% in the control group（n=47）， and the difference was statistically significant（χ2=8.26， P<0.01）. 102 cases were willing to receice treatment of（95.3%） in the study group were significantly higher than the reference group of 92 cases（86.0%）， and the difference was statistically significant（χ2=5.52， P<0.01）. Conclusion nitrous oxide conscious sedation assisted with gastroscopy in the treatment of upper gastrointestinal tract improves the comfort of treatment， with simple and safe operation， and is worthy of popularization and application.

[Key words] Nitrous oxide； Conscious sedation； Endoscopic treatment； Upper digestive tract foreign bodyendprint

上消化道异物属于消化内镜的急症，70%～75%的上消化道异物滞留于食管，以食管入口处最多见，其次为胃、十二指肠[1]。目前胃镜治疗上消化道异物在临床上已广泛开展，早期积极处理可最大程度减少出现严重并发症的机率。患者的依从性是影响治疗效果的主要因素[2]。为保证内镜治疗的顺利进行，我院消化内镜室在2014年6月～2016年5月间，使用吸入笑气的方法，清醒镇静辅助胃镜治疗上消化道异物107例，效果良好，现报道如下。

1 资料与方法

1.1 一般资料

选择我院2014年6月～2016年5月门诊消化内镜就诊的食管异物的患者214例，随机分为研究组和参照組，研究组为我院消化内镜室自愿接受笑气清醒镇静辅助胃镜治疗上消化道异物的患者107例，其中男55例，女52例，年龄18～70岁，平均年龄（51.6±3.8）岁，病程2 h～2.5 d，平均（16±7）h。……