右美托咪定与咪达唑仑用于无痛胃肠镜的效果分析

目的探讨和研究右美托咪定与咪达唑仑用于无痛胃肠镜检查的临床效果对比。方法研究对象选取为2010年2月—2013年8月之间我院行无痛胃肠镜检查的78例患者,采用随机分组方式分为两组,对照组39例采用咪达唑仑联合依托咪酯方案,观察组39例采用右美托咪定联合依托咪酯方案,在检查过程中如果患者存在体动反应,则追加依托咪酯4-6 mg,对两组患者各时段的生命体征、麻醉效果和不良反应进行统计对比。结果两组患者各时段的生命体征变化无显著差异（P〉0.05）;观察组患者的唤醒时间、依托咪酯用量以及不良反应发生率分别为：（5.7±2.1）、（15.8±2.7）、10.3%明显低于对照组的：（8.2±2.9）、（18.6±3.1）,66.7%,差异具有统计学意义（P〈0.05）。结论右美托咪定联合依托咪酯用于无痛胃肠镜检查的效果良好,相较于咪达唑仑具有麻醉效果好、安全性高的优势,值得在临床上推广和应用。     

Audit of coding in gastrointestinal endoscopy

The accuracy of the coding of gastrointestinal endoscopic procedures at Llandough Hospital was audited over 12 months. Although the endoscopy unit kept its own records, none of the staff were initially aware of the coding system used for endoscopic procedures for subsequent hospital activity analysis. Conventional typed discharge summaries were usually inadequate for coding purposes, and there was considerable variation in the proportion of procedures coded. Changes made to improve the accuracy and completeness of coding for endoscopic procedures were seen to be effective in a follow-up study.     

Safety of gastrointestinal endoscopy during pregnancy

There are only few data of gastrointestinal endoscopy in pregnant patients. Only 0.4% of all procedures are carried out during pregnancy. Case reports and some small retrospective studies are available. Because of physiological changes in pregnancy there might be special risks of endoscopy. There might be complaints which can be physiologic during pregnancy, but can be signs of gastrointestinal disorders, too. Therefore, indications for endoscopy are not always clear and easy. Safety of the procedures is also not well studied. Besides the risks of endoscopy, medication given to the mother, electrocoagulation and radiation exposure from fluoroscopy during endoscopic retrograde cholangiopancreatography might be harmful to the fetus. Endoscopy should only be done when indication is unquestionable and strong. Only FDA "A" and "B" category medication is allowed. Gastroscopy is necessary for bleeding and for patients with pyrosis going together with alarm signs. Nausea, vomiting, abdominal pain and fecal occult blood test positivity are not indications for endoscopy, only for gastroenterogical consultation. Sigmoidoscopy is recommended for indication of lower gastrointestinal bleeding and sigmoid or rectal mass. Only therapeutic endoscopic retrograde cholangiopancreatography should be performed. Obstructive jaundice and biliary pancreatitis need immediate endoscopic intervention. The fetus must be shielded from radiation exposure.     

Sedation and analgesia during gastrointestinal endoscopy

Sedative and analgesic premedication is frequently used during gastrointestinal endoscopy. Sedation improves patient's compliance, helping the examinations and their safe completion, but it lengthens the procedures, increases the costs, and complications can occur. Sedative drugs are applied during upper and lower gastrointestinal endoscopy, and also at ERCP. The review summarizes the different forms of sedation, drugs, future techniques and possibilities of improvements. Moreover, sedation practice in Hungary is also described.     

消化内镜医院感染的预防

目的 研究预防消化内镜医院感染的方法及消化内镜感染的护理措施,以完善消化内镜的诊治工作.方法 选取医院2010年1月-2012年12月进行消毒内镜诊疗的300例患者为研究组,给予新型预防消毒内镜医院感染的方法及消毒内镜感染的护理措施；将2009年1-10月100例患者为对照组,给予传统的预防消毒内镜医院感染的方法及消毒内镜感染的护理措施,比较两组患者诊疗后不良反应的发生情况.结果 研究组患者呛咳躁动率、恶心率、患者术后不适率分别为1.7％、2.0％、1.0％,对照组分别为15.0％、21.0％、11.0％,研究组均明显低于对照组,两组比较差异有统计学有意义(P＜0.05)；研究组的病原菌检出率为8.0％,对照组检出率为33.0％,两组比较差异有统计学意义(P＜0.05),两组均未发生败血症.结论 新型消毒内镜医院感染的预防和护理管理效果良好,避免了医院交叉感染.     

健康体检中内镜检查的应用价值

目的评价健康体检内镜检查临床价值和意义。方法回顾分析解放军总医院海南分院2012年08月01~2016年08月01所有在消化内镜中心接受健康体检内镜检查者的内镜和相关资料,包括年龄、性别、主诉、13C呼气试验结果、是否麻醉、术中或术后并发症、内镜诊断和病理结果等,评价健康体检内镜检查的有效性和安全性。结果接受健康体检内镜检查的患者共1 173例,男865例,女308例,平均年龄(52.5±9.9)岁,1 029例(88%)为无症状健康体检者;合计进行胃肠镜共2 275例次,其中麻醉下无痛胃肠镜2 130例次(93.6%);发现癌前病变28例(包括各种程度异型增生),明确消化道癌10例(0.85%),其中胃癌2例,结肠癌8例;10例癌症中早癌4例(40%),均经内镜或手术切除术后病理证实。经Logistic回归分析,消化道癌前病变及消化道癌与体检对象年龄、性别、幽门螺杆菌感染、主诉等无统计学相关(P0.05)。内镜诊治过程中黏膜出血48例(2.1%),均经内镜治疗成功,无其他严重及麻醉相关并发症。结论健康体检内镜检查可以有效发现消化道恶性病变,尤其是消化道早癌。经内镜确诊的恶性病变与患者年龄、性别、幽门螺杆菌感染、消化道症状等均无相关性。健康体检内镜检查具备较高安全性,术中出现相关并发症主要为出血,均可经内镜处理,严格的麻醉和监护可降低或避免相关风险。     

New devices for non-vascular interventional radiology

Interventional Radiology (IVR) is a field of medicine, which has made diagnosis or treatment previously performed only by surgery possible percutaneously. For safe and successful IVR, good devices are necessary. Therefore, development of new devices is essential for the progress of IVR. Various kinds of new devices for non-vascular IVR are introduced, including new biopsy needles, AccuStick, Cope Gastrointestinal Suture, R?sch-Thurmond Fallopian Tube Catheterization Set, ESP Glove and others. Most of them are now commercially available in Japan. However, all of them cost much higher than they cost in the USA.     

Upper gastrointestinal endoscopy in neonates--experience of pediatric gastroenterology unit

The aim of our study was to assess the frequency of the different lesions occurring as well as to precise indications of upper gastrointestinal endoscopy in neonates. Method :We have achieved a retrospective study about 128 neonatal gastrointestinal endoscopies. Three groups were constituted according to macroscopic findings: Group I: normal aspect (n=11); Group II: isolated esophagitis (n=19); Group III: esogastritis or gastroduodenitis or esogastroduodenitis (n=92). RESULTS: The neonates undergoing endoscopy for malaise were more frequent in group I than in group II and III, respectively 36.5% versus 15.8% and 9.8% (P = 0.04). Digestive hemorrhage (hematemesis and/or melena) was more frequent in group III than in group II and I, respectively 90.2% versus 78.9% and 63.6% (P = 0.03). Digestive hemorrhage was in our study the main indication of upper gastrointestinal endoscopy in neonates (85.9%) which showed a macroscopic lesion in 93.5% of cases. CONCLUSION: Hematemesis and suspicion of esophagitis are good indications for upper gastrointestinal endoscopy in neonates.     

消化道内镜检查患者感染的危险因素研究

目的探讨消化道内镜检查患者发生感染的情况,以了解其感染的主要危险因素,为临床治疗提供参考依据。方法选取2000年3月-2011年12月697例行消化道内镜检查住院患者,对行消化内镜发生感染患者进行病原菌培养,数据采用SPSS 16.0软件进行统计分析。结果共有55例发生感染,检出55株病原菌,以幽门螺杆菌为主,共36株占65.5%;logisic多因素回归分析结果显示,内镜消毒时间不足、检查室空气消毒不符合标准、检查人员手卫生不到位、内镜消毒不符合要求是消化道内径检查发生感染的独立危险因素(P<0.05)。结论幽门螺杆菌、假单胞菌属和沙门菌属是医院感染的主要病原菌,避免医院感染发生的危险因素,降低医院感染的发生率,保证患者和医疗工作者的安全是目前急需解决问题。     

Cardiac arrhythmias associated with upper gastrointestinal endoscopy in elderly subjects

Continuous Holter monitoring was performed before, during and after upper gastrointestinal endoscopy in 50 unselected, consecutive elderly patients (median age 80 years: range 68-89). In contrast to other studies the patients received no atropine or opiate premedication and were monitored for a prolonged period usually 24 hours after endoscopy. Comparison of a control period when the patient was lying at rest before endoscopy with the period of endoscopy itself revealed an increased frequency of arrhythmias during endoscopy. Forty-eight per cent of patients developed a new arrhythmia or an increased frequency of existing arrhythmia during endoscopy. All arrhythmias were short and self-terminating. Evidence of cardiac disease conferred a significantly increased risk of developing an arrhythmia during endoscopy.     

The role of upper gastrointestinal endoscopy in primary care.

Upper gastrointestinal endoscopy has become a very useful procedure in detecting pathology and aiding the physician in the evaluation of a patient's problem. A review of one year's sample of 176 examinations performed by a family physician in a small rural hospital shows that there was an 83 percent correlation between pathologic diagnoses of directed biopsies and endoscopic diagnoses. However, there was only a 40 percent correlation between routine radiologic findings and endoscopic findings. Upper gastrointestinal endoscopy has also proven to be a safe procedure that can be used to detect cancer more accurately, locate bleeding sites, and remove foreign bodies. This service can easily be made available to most patients by interested physicians.     

1868例静脉麻醉下胃肠镜检查术肠道准备健康教育分析

目的探讨影响患者肠道准备过程的因素。方法根据进行胃肠镜检查的时间先后顺序分组．2012年1～6月体检患者908例为对照组,2012年7～12月体检患者960例为实验组。对照组患者肠道准备的健康教育按常规;h-法进行．即每个班次都进行相同内容的教育;实验组患者肠道准备的健康教育分步进行,即护士将肠道准备方法及注意事项分3个班次进行宣教,不同班次宣教不同内容。结果2组患者肠道清洁效果比较,差异无统计学意义（u=0．282．P〉O．05）;实验组健康教育后,患者依从性明显提高（u=15．655,P〈0．01）,护士被再次咨询的次数减少（t=3．0902,P〈0．01）。患者对护士健康教育的满意度由对照组的91．5％提高至实验组的97．5％。结论实验组的健康教育模式,使患者得到了清晰、个性化的指导,患者肠道准备的依从性明显提高,患者对护士的服务满意度明显提高,有利于大夜班护士工作的计划性。     

Development of fiber endoscopes and some aspects of gastrointestinal endoscopy]

Clinical evaluation of the up-to-date fibre endoscope models makes it possible to set apart 3 successive stages in the course of creating gastro-intestinal endoscopy, viz. construction of instruments with side optics, making esophagofibroscopes with end optics and transformation of esophagofibroscopes into panendoscopes. Depending upon the nature of the disease and the diagnostic objectives to be fulfilled various types of fibre endoscopes, both new and old, are recommended for clinical use.