目的 探讨无痛苦消化内镜(简称无痛内镜)在西藏高原地区临床应用的可行性和安全性。方法 将武警西藏总队医院2015-07至2016-06行无痛内镜检查的810例患者作为无痛组,随机选取同期行普通内镜检查的810例患者作为普通组。观察无痛组患者检查前、中、后,BP、HR、RR、SpO₂的变化,另记录并比较两组患者内镜检查完成率、患者对内镜检查的舒适度、满意度、同意再次内镜检查率、内镜医师对内镜下视野及蠕动的满意度、不良反应。结果 无痛组患者检查中SpO₂较检查前下降8.2%,差异有统计学意义(P<0.05),但均为一过性,经相应处理,检查后均可恢复至检查前水平。无痛组810例患者均完成检查,发生一过性呼吸抑制12例,呛咳2例;普通组中的805例完成检查,发生恶心、呕吐426例。无痛组患者对内镜检查的舒适度、满意度、同意再次内镜检查率、内镜医师对内镜下视野及蠕动的满意度均高于普通组,比较均有统计学差异(P<0.05)。结论 无痛内镜在西藏高原地区临床应用是可行的、安全的,且患者舒适、满意,内镜下视野好,值得临床进一步推广应用;但应注意其一过性呼吸抑制不良反应。

Objective To study the feasibility, safety and adverse reactions of painless endoscopy performing on the Tibet plateau.Methods Eight hundreds and ten patients who had received painless endoscopy in Tibet Corps Hospital of PAP between July 2015 and June 2016 were enrolled in the experiment group (painless group), while another 810 patients who had received conventional endoscopy in the same period were enrolled randomly in the control group (conventional group).The changes of blood pressure(BP), heart rate(HR), respiration rate (RR), blood Oxygen saturation (SpO₂) before, in the middle of and after the painless endoscopy inspection were observed. The endoscopic completion rate, degree of comfort, satisfaction with the operation, acceptability of the endoscopic examination, the operators’ degree of satisfaction with the endoscopic vision and gastrointestinal movements, and the adverse reactions were recorded and compared between the two groups.Results SpO₂ in the middle of endoscopic inspection was decreased by 8.2 percent compared with that before the inspection in painless group, and the difference was of statistical significance (P<0.05). However, the decline of SpO₂ was transient so that the postoperative SpO₂ could return to the preoperative level after corresponding treatment. All the patients in painless group finished the examination. There were twelve cases of transient respiratory depression and two cases of cough due to adverse reactions in painless group. 805 patients in control group finished the examination. There were 426 cases of nausea and vomiting out of adverse reactions in control group. The completion rate of endoscopy, degree of comfort, satisfaction with the operation, acceptability of the endoscopic examination, the operators’ degree of satisfaction with the endoscopic vision and gastrointestinal movements in painless group were higher than in control group, and there were statistically significant differences (P<0.05) between the two groups.Conclusions The application of painless endoscopy on the Tibet plateau is feasible and safe. The patients feel comfortable and satisfied. The endoscopic vision is better. Painless endoscopy is worthy of clinical popularization on the plateau, but attention should be paid to the adverse reaction of transient respiratory depression.