老年及卧床患者非镇静经鼻超细胃镜检查。
Unsedated transnasal small-caliber esophagogastroduodenoscopy in elderly and bedridden patients.
机构信息
Division of Internal Medicine, Izumo-City General Medical Center, Izumo-shi, Shimane, Japan.
出版信息
World J Gastroenterol. 2009 Nov 28;15(44):5586-91. doi: 10.3748/wjg.15.5586.
AIM
To evaluate the safety of unsedated transnasal small-caliber esophagogastroduodenoscopy (EGD) for elderly and critically ill bedridden patients.
METHODS
One prospective randomized comparative study and one crossover comparative study between transnasal small-caliber EGD and transoral conventional EGD was done (Study 1). For the comparative study, we enrolled 240 elderly patients aged > 65 years old. For the crossover analysis, we enrolled 30 bedridden patients with percutaneous endoscopic gastrostomy (PEG) (Study 2). We evaluated cardiopulmonary effects by measuring arterial oxygen saturation (SpO(2)) and calculating the rate-pressure product (RPP) (pulse rate x systolic blood pressure/100) at baseline, 2 and 5 min after endoscopic intubation in Study 1. To assess the risk for endoscopy-related aspiration pneumonia during EGD, we also measured blood leukocyte counts and serum C-reactive protein (CRP) levels before and 3 d after EGD in Study 2.
RESULTS
In Study 1, we observed significant decreases in SpO(2) during conventional transoral EGD, but not during transnasal small-caliber EGD (0.24% vs -0.24% after 2 min, and 0.18% vs -0.29% after 5 min, P = 0.034, P = 0.044). Significant differences of the RPP were not found between conventional transoral and transnasal small-caliber EGD. In Study 2, crossover analysis showed statistically significant increases of the RPP at 2 min after intubation and the end of endoscopy (26.8 and 34.6 vs 3.1 and 15.2, P = 0.044, P = 0.046), and decreases of SpO(2) (-0.8% vs -0.1%, P = 0.042) during EGD with transoral conventional in comparison with transnasal small-caliber endoscopy. Thus, for bedridden patients with PEG feeding, who were examined in the supine position, transoral conventional EGD more severely suppressed cardiopulmonary function than transnasal small-caliber EGD. There were also significant increases in the markers of inflammation, blood leukocyte counts and serum CRP values, in bedridden patients after transoral conventional EGD, but not after transnasal small-caliber EGD performed with the patient in the supine position. Leukocyte count increased from 6053 +/- 1975/L to 6900 +/- 3392/L (P = 0.0008) and CRP values increased from 0.93 +/- 0.24 to 2.49 +/- 0.91 mg/dL (P = 0.0005) at 3 d after transoral conventional EGD. Aspiration pneumonia, possibly caused by the endoscopic examination, was found subsequently in two of 30 patients after transoral conventional EGD.
CONCLUSION
Transnasal small-caliber EGD is a safer method than transoral conventional EGD in critically ill, bedridden patients who are undergoing PEG feeding.
目的
评估对接受经皮内镜胃造口术（PEG）的老年和重症卧床患者行非镇静经鼻小口径食管胃十二指肠镜检查（EGD）的安全性。
方法
我们进行了一项前瞻性随机对照研究和一项经鼻小口径 EGD 与经口传统 EGD 的交叉对照研究（研究 1）。在对照研究中，我们纳入了 240 名年龄 > 65 岁的老年患者。在交叉分析中，我们纳入了 30 名接受 PEG 的卧床患者（研究 2）。我们在研究 1 中在基线、内镜插管后 2 分钟和 5 分钟时通过测量动脉血氧饱和度（SpO2）和计算心率-收缩压乘积（RPP）[脉搏率 x 收缩压/100]来评估心肺效应。为了评估 EGD 相关吸入性肺炎的风险，我们还在研究 2 中在 EGD 前后测量了白细胞计数和血清 C 反应蛋白（CRP）水平。
结果
在研究 1 中，我们观察到经口传统 EGD 过程中 SpO2 显著下降，但经鼻小口径 EGD 过程中 SpO2 无显著下降（2 分钟后分别下降 0.24% 和 -0.24%，5 分钟后分别下降 0.18% 和 -0.29%，P = 0.034，P = 0.044）。经口传统 EGD 和经鼻小口径 EGD 之间的 RPP 差异无统计学意义。在研究 2 中，交叉分析显示，与经鼻小口径 EGD 相比，经口传统 EGD 在插管后 2 分钟和内镜检查结束时的 RPP 显著增加（分别为 26.8 和 34.6 与 3.1 和 15.2，P = 0.044，P = 0.046），并且 SpO2 下降（-0.8%与 -0.1%，P = 0.042），这表明在仰卧位接受检查的 PEG 喂养卧床患者中，经口传统 EGD 比经鼻小口径 EGD 更严重地抑制心肺功能。经口传统 EGD 后，卧床患者的炎症标志物白细胞计数和血清 CRP 值也显著升高，但经鼻小口径 EGD 后则无此升高。白细胞计数从 6053 +/- 1975/L 增加到 6900 +/- 3392/L（P = 0.0008），CRP 值从 0.93 +/- 0.24 增加到 2.49 +/- 0.91 mg/dL（P = 0.0005），这是在经口传统 EGD 后 3 天发现的。经口传统 EGD 后，30 名患者中有 2 名随后被发现患有可能由内镜检查引起的吸入性肺炎。
结论
在接受 PEG 治疗的重症、卧床的患者中，经鼻小口径 EGD 比经口传统 EGD 更安全。
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