28万例无痛胃镜中不良事件的分析及防治

发布时间：2018-10-21 12:06

【摘要】：目的分析总结无痛胃镜不良事件发生的情况及防治措施。方法回顾吉林大学白求恩第一医院2008年1月1日至2015年12月31日8年共28万例无痛胃镜检查患者的相关资料及检查经过,包括年龄、性别、吸烟、体重指数、高血压、冠心病、糖尿病、脑血管病、胃手术方式等。结果无痛胃镜检查不良事件多发生于男性中老年人。死亡老年男性1例,死亡原因推测为食管蒂样"息肉"退镜时返折至咽喉部致气道阻塞窒息;合并心肌梗死老年男性1例,经抢救后康复;短暂性脑缺血发作1例;呼吸暂停、心肺复苏致肋骨骨折1例;误吸至气道,呼吸机抢救后合并吸入性肺炎2例;4 680例患者出现血氧饱和度下降至30%,甚至为0,经面罩吸氧及人工辅助呼吸后康复;出现腹泻2例;术前1 d心电图检查正常,次日行胃镜检查时突发大面积心肌梗死1例;诱发癔病发作1例。结论无痛胃镜不良事件的发生多集中于中老年男性,这与男性吸烟、糖尿病、高血压、肥胖、冠心病等密切相关。误吸致吸入性肺炎多发生于胃潴留、胃癌术后的患者;若术前能通过查体、胃超声、CT等检查排除胃潴留,可避免误吸、肺炎等不良事件的发生。术前认真评估病情,完善心肌酶学、肺功能等检查,可避免不良事件发生。应用超细内镜检查对中老年人相对安全快捷。
[Abstract]:Objective to analyze and summarize the occurrence and prevention of painless gastroscopy adverse events. Methods from January 1, 2008 to December 31, 2015, 280000 patients with painless gastroscopy, including age, sex, smoking, body mass index, hypertension, coronary heart disease, were reviewed retrospectively, including age, sex, smoking, body mass index, hypertension and coronary heart disease. Diabetes, cerebrovascular disease, gastric operation, etc. Results the adverse events of painless gastroscopy mostly occurred in middle and old men. One elderly man died, the cause of death was presumed to be airway obstruction and asphyxia caused by reflexion of esophagus pedicle polyp to pharynx and larynx, 1 elderly man with myocardial infarction, recovered after rescue, 1 case with transient ischemic attack, 1 case with apnea, 1 case with acute myocardial infarction, 1 case with transient ischemic attack, 1 case with temporary ischemic attack, and 1 case with apnea. There were 1 case of rib fracture caused by cardiopulmonary resuscitation, 2 cases of respiratory tract aspiration, 2 cases of inhaled pneumonia after ventilator rescue, 4 680 cases of patients with decreased blood oxygen saturation to 30% or even 0, recovered by mask oxygen inhalation and artificial assisted respiration, 2 cases of diarrhea. The electrocardiogram was normal 1 day before operation, 1 case of sudden massive myocardial infarction and 1 case of hysteria occurred the next day after gastroscopy. Conclusion the incidence of painless gastroscopic adverse events is mostly concentrated in middle-aged and elderly men, which is closely related to smoking, diabetes, hypertension, obesity, coronary heart disease and so on. Aspiration pneumonia mainly occurred in patients with gastric retention and gastric cancer after operation. If we can eliminate gastric retention by examination of body examination, gastric ultrasound, CT and so on, we can avoid the occurrence of mis-aspiration, pneumonia and other adverse events. The adverse events can be avoided by carefully evaluating the condition before operation, improving myocardial enzymology and pulmonary function. Ultrafine endoscopy is relatively safe and fast for middle and old people.
【作者单位】：吉林大学白求恩第一医院胃肠内科;吉林大学白求恩第一医院老年内科;
【分类号】：R57

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